Free intraabdominal catheter management post-VP shunt disconnection in pediatric patients: systematic review

Ventriculoperitoneal (VP) shunting is the standard treatment for pediatric hydrocephalus but carries a high complication rate, including mechanical failure. Distal catheter disconnection and intraabdominal migration present a unique clinical dilemma: whether to retrieve or observe the retained catheter. This systematic review evaluates reported management strategies and outcomes associated with free intraabdominal catheter fragments post-VP shunt disconnection in pediatric patients. A comprehensive literature search was conducted across PubMed, Ovid, Scopus, Embase, and Google Scholar using predefined terms. A total of 4721 unique records were screened; 31 full texts were reviewed, and 11 articles met inclusion criteria. Eligible studies involved pediatric patients with disconnected VP shunts and retained peritoneal catheters, with management details and clinical outcomes. Data extraction and NIH-based quality assessment were independently performed by two reviewers. The final analysis included 11 studies (six case series, five case reports) involving 36 patients. Laparoscopic retrieval was the predominant technique (in 10 of 11 studies), often enabling concurrent catheter replacement. Outcomes were consistently favorable, with no major complications and minimal postoperative morbidity. One study required conversion to laparotomy due to visceral adhesion. Conservative management was rarely employed and not supported by outcome data. Quality assessment rated most studies as good. Free intraabdominal VP shunt catheters in pediatric patients should be retrieved when safely feasible. Laparoscopic management appears highly effective and low risk. Despite limited high-level evidence, the literature supports early elective removal to prevent delayed complications.