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


  • Rajendra K. Ghritlaharey Department of Pediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India



Children, Complication, Extrusion, Hydrocephalus, Infants, Vagina, VPS, VPS revision


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.

Author Biography

Rajendra K. Ghritlaharey, Department of Pediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India

Prof and Head, Department  of Pediatric  Surgery,                  Gandhi  Medical  College, Bhopal 462001, India


Isaacs AM, Riva-Cambrin J, Yavin D, Hockley A, Pringsheim TM, Jette N et al. Age-specific global epidemiology of hydrocephalus: Systematic review, metanalysis and global birth surveillance. PloS One. 2018;13:e0204926.

Dewan MC, Rattani A, Mekary R, Glancz LJ, Yunusa I, Baticulon RE et al. Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. J Neurosurg. 2019;130:1065-79.

Stagno V, Navarrete EA, Mirone G, Esposito F. Management of hydrocephalus around the world. World Neurosurg. 2013;79:S23.e17-20.

Rizvi I, Garg RK, Malhotra HS, Kumar N, Sharma E, Srivastava C et al. Ventriculo-peritoneal shunt surgery for tuberculous meningitis: A systematic review. J Neurol Sci. 2017;375:255-63.

Ghritlaharey RK, Budhwani KS, Shrivastava DK, Srivastava J. Ventriculoperitoneal shunt complications needing shunt revision in children: A review of 5 years of experience with 48 revisions. Afr J Paediatr Surg. 2012;9:32-9.

Merkler AE, Ch'ang J, Parker WE, Murthy SB, Kamel H. The rate of complications after ventriculoperitoneal shunt surgery. World Neurosurg. 2017;98:654-8.

Mansoor N, Solheim O, Fredriksli OA, Gulati S. Revision and complication rates in adult shunt surgery: a single-institution study. Acta Neurochir (Wien). 2021;163:447-54.

Donoho DA, Buchanan IA, Rangwala SD, Patel A, Ding L, Giannotta SL et al. Readmissions after ventricular shunting in pediatric patients with hydrocephalus: A nationwide readmissions database analysis. J Neurosurg Pediatr. 2021:1-10.

Ghritlaharey RK, Budhwani KS, Shrivastava DK, Gupta G, Kushwaha AS, Nanda M et al. Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int. 2007;23:575-80.

Miranda ME, de Sousa MB, Tatsuo ES, Quites LV, Giannetti AV. Bladder perforation by ventriculoperitoneal shunt. Childs Nerv Syst. 2016;32:2321-6.

Faheem M, Jaiswal M, Prajapati HP, Kumar R, Saba Nu, Ojha BK. Unusual complications of ventriculoperitoneal shunt surgery: Tertiary care experience. J Pediatr Neurosci. Available at: Accessed on 04 October 2021.

Ghritlaharey RK. Review of the management of peroral extrusion of ventriculoperitoneal shunt catheter. J Clin Diagn Res. 2016;10:PE01-6.

Patel CD, Matloub H. Vaginal perforation as a complication of ventriculoperitoneal shunt. Case report. J Neurosurg. 1973;38:761-2.

Mozingo JR, Cauthen JC. Vaginal perforation by a Raimondi peritoneal catheter in an adult. Surg Neurol. 1974;2:195-6.

Pianetti Filho G, Cabral G, Fonseca LF, al Filho JA. Vaginal perforation as complication of ventriculo-peritoneal shunt: report of a case. Arq Neuropsiquiatr. 1991;49:362-4.

Pereira CU, da Silva AD, Gonzaga AKV, Santos JD. Extrusão do cateter peritoneal pela vagina. Arq Bras Neurocir. 1999;18:49-50.

Farrokhi M, Tavallaee G. Unusual migration of the distal catheter of a ventriculoperitoneal shunt into the vagina. Iran J Med Sci. 2007;32:182-4.

Kumar B, Sharma SB, Singh DK. Extrusion of ventriculo-peritoneal shunt catheter. Indian J Pediatr. 2010;77:336.

Altas M, Tutanc M, Aras M, Altas ZG, Arica V. Vaginal perforation caused by distal tip of ventriculoperitoneal shunt: Report of a rare complication. Pak J Med Sci. 2012;28:550-1.

Teegala R, Kota LP. Unusual complications of ventriculo peritoneal shunt surgery. J Neurosci Rural Pract. 2012;3:361-4.

Bonfield CM, Weiner GM, Bradley MS, Engh JA. Vaginal extrusion of a ventriculo-peritoneal shunt catheter in an adult. J Neurosci Rural Pract. 2015;6:97-9.

Tavallaee SG. Unusual migration of ventriculo peritoneal distal catheter into vagina. ISMJ. 2015;18:235-8.

Lotfinia I, Tubbs S, Mahdkhah A. Vaginal extrusion of a ventriculoperitoneal shunt: A case report and review of literature. J Pediatr Adolesc Gynecol. 2017;30:e23-5.

Houten JK, Smith S, Schwartz AY. Vaginal migration of ventriculoperitoneal shunt catheter and crebrospinal fluid leak as a complication of hysterectomy. World Neurosurg. 2017;104:1046.e13-14.

Chugh A, Gotecha S, Amle G, Patil A, Punia P, Kotecha M. Abnormal migration and extrusion of abdominal end of ventriculoperitoneal shunt: An experience of eight cases. J Pediatr Neurosci. 2018;13:317-21.

Soufiany I, Hijrat KA, Soufiany S, Chen L. Mechanisms and major sites of distal catheter migration in ventriculoperitoneal shunting maneuvers: A review article. Brain Sci Advances. 2018;4:141-55.

Korulmaz A, Alakaya M, Kaya S, Hamzaoglu V, Tezol Ö, Arslanköylü AE. A rare cause of vaginal foreign body: Ventriculoperitoneal shunt migration. J Pediatr Neurosci. 2019;14:109.

Sahinturk F, Sonmez E, Altinors N. Spontaneous vaginal extrusion of the distal catheter of a ventriculoperitoneal shunt. Cesk Slov Neurol N. 2020;83:207-8.

Lord S, Robinson T, Spurgas M. Ventriculoperitoneal shunt migration with vaginal extrusion via the fallopian tube. J Pediatric Surg Case Rep. 2020;57:101468.

Hidayat I, Syahputra DA, Isa MM. Unusual migration of distal ventriculoperitoneal shunt to vagina via fallopian tube: A case report. Ann Med Surg (Lond). 2021;63:102158.

Aghazadeh J, Mehrzad SM. Extrusion of ventriculo peritoneal through the vagina shunt catheter. J Urmia University of Med Sci. 2008;18:688-90.

Sells CJ, Loeser JD. Peritonitis following perforation of the bowel: a rare complication of a ventriculoperitoneal shunt. J Pediatr. 1973;83:823-4.

Ezzat AAM, Soliman MAR, Hasanain AA, Thabit MA, Elshitany H, Kandel H et al. Migration of the distal catheter of ventriculoperitoneal shunts in pediatric age group: Case series. World Neurosurg. 2018;119:e131-7.

Sinha VD, Bhardwaj S, Purohit D, Chopra S. Unusual extrusion of distal end of ventriculoperitoneal shunt: Case series with literature review. Interdisciplinary Neurosur. 2021;24:101026.

Liang R, Yang X, Liu Y, Zhang Y. Extrusion of the distal end of ventriculoperitoneal shunt through the urethral orifice in an adult male. Neurol India. 2021;69:230-1.

Shah AS, Singh D, Loomba P, Singh H, Mittal A, Srivastava S. Peroral extrusion of ventriculoperitoneal shunt: An unusual complication and review of literature. Ind J Neurosurg. 2016;5:196-201.

Feeney V, Ansar N, Donaldson-Hugh B, Alalade AF. Transoral protrusion of a ventriculoperitoneal catheter caused by jejunal perforation in an adult: rare case report and review of the literature. World Neurosurg. 2020;137:200-5.

Nagulic M, Djordjevic M, Samardzic M. Peritoneo-vulvar catheter extrusion after shunt operation. Childs Nerv Syst. 1996;12:222-3.

Washington EC, Holmes M, Haines SJ, Ringwood JW. Ventriculoperitoneal shunt migration presenting with vaginal discharge and hydrosalpinx in a 16-year-old patient. Pediatr Emerg Care. 2002;18:28-30.

Faquini IV, Fonseca RB, Junior AB, de Albuquerque Leimig BC, e Silva EJ, Lima LS et al. Vaginal cerebrospinal fluid discharge due to fallopian tube perforation by distal catheter of ventriculoperitoneal shunt: A case report. Interdisciplinary Neurosur. 2021;23:100977.

Poilblanc M, Sentilhes L, Mercier P, Lefèbvre C, Descamps P. Uterine perforation by a cystoperitoneal shunt, an unusual cause of recurrent vaginal discharge. J Obstet Gynaecol Can. 2012;34:63-5.




How to Cite

Ghritlaharey, R. K. (2021). Management of trans-vaginal extrusion of the distal ventriculoperitoneal shunt catheter: a systematic literature review from 1973 to 2021. International Journal of Research in Medical Sciences, 9(11), 3416–3423.



Systematic Reviews