Shunt-preserving laparoscopic management of transanal ventriculoperitoneal shunt catheter protrusion without peritonitis: illustrative case

BACKGROUND Transanal protrusion of a ventriculoperitoneal (VP) shunt catheter is an uncommon manifestation of bowel perforation. Most reports favor shunt removal or externalization because retrograde contamination may cause ventriculitis, meningitis, peritonitis, or sepsis. OBSERVATIONS A 69-year-old man with posttuberculous hydrocephalus and bilateral VP shunts presented 20 days after trocar-assisted left distal catheter reinsertion with the catheter protruding 2 cm beyond the anus. He was afebrile and without peritonitis or meningismus. Recent CSF testing showed clear, colorless CSF with minimal pleocytosis, negative acid-fast bacilli smear, and no fungal growth. CT showed the left distal catheter in the rectal lumen without free air or fluid. Laparoscopy showed no enteric fluid or pus; the right shunt catheter remained functional, and the left catheter penetrated the sigmoid colon. The intraluminal segment was removed transanally, the sigmoid defect was closed laparoscopically with 3-0 polydioxanone, and the proximal shunt system was preserved. Ceftriaxone was administered for 14 days. LESSONS In highly selected shunt-dependent patients without peritonitis, abscess, gross contamination, or CNS infection, laparoscopy can define contamination, permit bowel repair, and support cautious shunt preservation with close follow-up. https://thejns.org/doi/10.3171/CASE26487