The Gut-Brain Axis: A Case Report of Transanal Extrusion of a Ventriculoperitoneal Shunt and Literature Review

Ventriculoperitoneal shunts (VPS) are widely used for the management of hydrocephalus but may rarely cause spontaneous bowel perforation, a potentially life-threatening complication associated with significant morbidity and mortality. This report describes an 81-year-old male who presented with transanal extrusion of VPS tubing six months after shunt placement, without abdominal pain, peritonitis, or systemic signs of infection. Imaging demonstrated catheter perforation of the descending colon with intraluminal migration to the rectum. The patient underwent multidisciplinary management, including shunt removal, exploratory laparotomy, primary colonic repair, and targeted antimicrobial therapy, with an uncomplicated recovery. To contextualize this case, a focused literature review identified 30 reported adult cases of VPS-associated spontaneous bowel perforation. Review findings indicate that cases in adults often progress slowly, with a substantial proportion identified by chance or after catheter protrusion without any abdominal symptoms, and a relatively low overall mortality rate, largely due to infections. Proposed risk factors include bowel wall compromise from chronic inflammation, prior surgery, or diverticular disease, while chronic catheter irritation may contribute to gradual erosion and contained perforation. Management strategies reported in the limited literature available vary significantly and include shunt externalization, endoscopic or laparoscopic catheter removal, and laparotomy in cases of peritonitis or instability. This case highlights the importance of maintaining clinical vigilance for VPS-related bowel perforation in adults, even in asymptomatic patients. It underscores the need for early imaging, multidisciplinary collaboration, and individualized management to prevent ascending infection and optimize outcomes.