Endoscopic management of anal protrusion of ventriculo-peritoneal shunt

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Neurosurgery

Background:

• Ventriculo-peritoneal shunts are used to treat hydrocephalus, a condition involving excess cerebrospinal fluid in the brain.
• Tuberculous meningitis can lead to hydrocephalus requiring surgical intervention with shunt placement.
• Shunt complications, though rare, can include migration and extrusion through various body orifices.

Observation:

• A 2-year-old male presented with the distal end of his ventriculo-peritoneal shunt protruding from the anus.
• Endoscopic examination confirmed the shunt's migration through the colon, 22 cm from the anal verge.
• The shunt's cranial end and a malfunctioning valve were surgically disconnected prior to removal.

Findings:

• Successful endoscopic removal of the migrated ventriculo-peritoneal shunt using a pediatric flexible colonoscope.
• This minimally invasive technique avoided the need for a laparotomy or repeat abdominal surgery.
• The procedure effectively resolved the shunt complication and restored normal anatomy.

Implications:

• Highlights the possibility of rare shunt migrations and the importance of vigilant post-operative monitoring.
• Demonstrates the utility of endoscopic retrograde removal for complex shunt complications.
• Offers a less invasive alternative for managing gastrointestinal shunt extrusions in pediatric patients.