Management of trans-vaginal extrusion of the distal ventriculoperitoneal shunt catheter: a systematic literature review from 1973 to 2021

Abstract

Trans-vaginal extrusion of the distal ventriculoperitoneal shunt (VPS) catheter is a rare complication of VPS insertion done for the treatment of hydrocephalus. The primary purpose was to review the demographics. The secondary objectives were to review the clinical presentation, operative intervention executed, and outcome of the cases published on trans-vaginal extrusion of the distal VPS catheter. The literature and case reports were retrieved from 1973 to September 30, 2021. This literature review included (n=19) cases of the above-mentioned VPS complication. The mean age of 15 children at the time of diagnosis of the complication was 18.13 months and ranged from 2 to 72 months. For the entire case, the interval from the initial VPS insertion/VPS revision to the clinical diagnosis of complication ranged from 1 to 36 months, with a mean of 8.16 months. In three-fourth of the cases, it was detected within 6-months of the VPS implantation. Extrusion of the distal VPS catheter through the vagina was the chief complaint. Surgical procedures were performed in the following order of frequency (A) removal of the entire VPS catheter (n=14), and (B) removal of the distal/peritoneal VPS catheter (n=3). During the postoperative period, one of the children died. Extrusion of the distal VPS catheter through the vaginal orifice is a rare complication of VPS insertion. It occurred across all the age groups but was more common during early childhood. Three-fourth of them were treated by removal of the entire VPS catheter. For VPS revision, delayed re-VPS insertion was the preferred option.