Transoral extrusion of ventriculoperitoneal shunt distal segment: A case report of very rare complication

• Migration of VPS tip through various body cavities and openings is a rare but serious complication. • A visible protrusion of the VPS tip was noted emerging through the oral cavity, with the extent increasing when the patient cried. • A small skin incision was made around the previous right upper quadrant scar to expose the shunt, which was then severed, and the distal portion was pulled through the oral cavity without difficulty. • When a patient presents with transoral extrusion of a distal VPS segment, the stomach is typically the most common site of perforation. • Subsequent management involves monitoring the patient for signs of peritonitis, central nervous system infection, and progression of the underlying hydrocephalus. Ventriculoperitoneal shunts (VPS) are a widely utilized neurosurgical intervention for managing hydrocephalus of diverse etiologies. While generally a safe and well-established treatment approach, VPS procedures are not without potential complications. The most frequently reported issues include infection, obstruction, disconnection or fracture of the shunt hardware, as well as skin erosion and overdrainage and tip migration. Migration of VPS tip through various body cavities and openings is a rare but serious complication. Transoral extrusion of the distal segment of a VPS is an exceedingly uncommon complication with only 43 case reports in the literature. We report a case of 2-year-old male pediatric patient presented with the extrusion of VPS distal tip through the oral cavity. The patient underwent thorough investigation including shunt series. The patient was optimized and empiric broad-spectrum antibiotic administration and was subsequently taken to the operating room for shunt revision. The patient had favorable surgical outcome. Transoral migration of the distal VPS component is an uncommon yet serious complication following VPS placement. This complication is primarily observed in pediatric patients within the first year after the initial VPS procedure. Most instances can be addressed by removing the distal segment, either through the oral cavity or the abdomen. Subsequent management involves monitoring the patient for signs of peritonitis, central nervous system infection, and progression of the underlying hydrocephalus. Prompt antibiotic treatment is required for any identified infections, and the hydrocephalus is managed by either inserting a new VPS or replacing only the distal segment.