Delayed transanal extrusion of a ventriculoperitoneal shunt in an adult patient: A rare delayed gastrointestinal complication following post-hemorrhagic hydrocephalus

Background: Ventriculoperitoneal shunting remains a standard treatment for hydrocephalus, including post-hemorrhagic hydrocephalus after aneurysmal subarachnoid hemorrhage. Gastrointestinal perforation with transanal extrusion of the distal catheter is exceptionally rare, particularly in adults. Case Description: We report a 51-year-old woman with a history of recurrent aneurysmal subarachnoid hemorrhage treated endovascularly, who developed post-hemorrhagic hydrocephalus requiring VP shunt implantation in 2021. More than four years later, she presented with a tube-like structure protruding from the anus after defecation, accompanied by headache and dizziness but without abdominal pain, fever, or signs of peritonitis. CT demonstrated chronic sigmoid colon perforation with intraluminal migration and transanal extrusion of the distal shunt catheter, while cranial imaging showed stable ventricles and correct proximal catheter position. Emergency laparoscopic management with adhesiolysis, controlled catheter transection and shortening, transanal removal of the intraluminal segment, primary colonic closure, lavage, and drainage was performed. The postoperative course was neurologically uneventful, with no evidence of meningitis, ventriculitis, or positive CSF cultures. The patient later required readmission for localized abdominal inflammatory changes and a small culture-negative fluid collection, which improved with intravenous antibiotics. Conclusion: Transanal VP shunt extrusion in adults is a rare delayed complication that likely reflects slow bowel wall erosion. Early recognition and individualized multidisciplinary management may prevent infectious sequelae and allow preservation of shunt function in selected cases.