Bowel perforation and anal ventriculoperitoneal shunt migration: A systematic review.

BACKGROUND: One of the most feared complications of hydrocephalus is shunt migration. Although rare, bowel migration is the most commonly encountered type of migration. The relatively high frequency of this occurrence allowed us to gather a substantial number of reports for study.

OBJECTIVES: The aim of this study was to better understand this complication and aid in decreasing its incidence.

METHODS: The PubMed and Scopus databases were searched for cases of anal shunt migration. In total, 49 records describing 56 clinical cases were included in this review. Additionally, we present and include the clinical case of a patient managed by our team; therefore, 57 cases were included in this study. Relevant parameters were collected, organized, analyzed, and discussed. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement from 2009.

RESULTS: Extrusion through the anus was observed in 82% of cases, 68% of which were in males. The age range varied from 1 month to 75 years. Congenital hydrocephalus was the etiology in 66% of cases. The time interval between shunt insertion and migration varied from 12 days to 19 years. In 70% of patients, the tube was pulled out through the anus, whereas a laparotomy or laparoscopy was used in 14% of cases. Infectious complications were noted in 35% of patients. The overall outcome was mostly favorable; two patients died as a complication of the migration.

CONCLUSIONS: Bowel and anal shunt migration is a relatively rare complication occurring predominantly within the initial weeks after the initial surgery. This condition leads to infectious complications, which can potentially be life-threatening. Urgent management is required, and in most cases, the removal of the shunt through the anus is sufficient. Early intervention generally results in favorable outcomes.