Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Dec 9, 2023; 12(5): 331-349
Published online Dec 9, 2023. doi: 10.5409/wjcp.v12.i5.331
Migration of the distal ventriculoperitoneal shunt catheter into the stomach with or without trans-oral extrusion: A systematic literature review and meta-analysis
Rajendra Kumar Ghritlaharey
Rajendra Kumar Ghritlaharey, Department of Paediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Bhopal 462001, Madhya Pradesh, India
Author contributions: All authors have read and approved the final, revised manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009/2021 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rajendra Kumar Ghritlaharey, MBBS, MS, MCh, Professor, Department of Paediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Royal Market, Bhopal 462001, Madhya Pradesh, India. drrajendrak1@rediffmail.com
Received: June 25, 2023
Peer-review started: June 25, 2023
First decision: August 17, 2023
Revised: September 4, 2023
Accepted: October 30, 2023
Article in press: October 30, 2023
Published online: December 9, 2023
ARTICLE HIGHLIGHTS
Research background

Intra-gastric migration of the distal ventriculoperitoneal shunt (VPS) catheter clinically presenting with or without trans-oral extrusion is one of the rare complications of VPS catheter insertion.

Research motivation

To know more about the intra-gastric migration of the distal VPS catheter.

Research objectives

This systematic review of the literature aims to highlight the demographics, clinical characteristics, and outcome of the surgical procedures performed for the intra-gastric migration of the distal VPS catheter, clinically presented with or without trans-oral extrusion of the distal end of peritoneal/VPS catheter.

Research methods

An online search was carried out for extraction/retrieval of published literature about the intra-gastric migration of the distal VPS catheter. PubMed, PubMed Central, ResearchGate, Google Scholar, and Google Images databases were searched using various terminology relating to the VPS complications. Manuscripts were retrieved from 1980 to December 2022. The selection of literature for the present review was done by assessing the titles, abstracts, and full texts of the manuscripts.

Research results

A total of n = 46 cases of intra-gastric migration of the distal VPS catheter clinically presented with or without peroral extrusion were recruited for the systematic review and were retrieved from the n = 46 manuscripts. Approximately sixty percent of them were children ≤ 5 years of age at the time of diagnosis of the complication mentioned above. In seventy-two percent of cases, this complication was detected within 24 mo after the VPS insertion/last shunt revision. Removal of the entire VPS catheter/removal of part of the distal/distal VPS catheter with or without external ventricular drainage was preferred by the authors. Percutaneous surgical removal of the entire or the distal VPS catheter with or without external ventricular drainage was a procedure of choice and was opted for n = 27 cases. For the management of VPS complications mentioned above, formal laparotomy was carried out only in n = 11 cases. In eighty-five percent of cases, the site of bowel perforation was the stomach. The site of bowel perforation was repaired only in n = 11 cases.

Research conclusions

Intra-gastric migration of the peritoneal end of a VPS catheter is one of the rare complications of VPS catheter implantation done for the treatment of hydrocephalus across all age groups. It was more frequently reported in children, although also reported in adults and older people. Formal exploration of the abdomen for the management of the VPS complication described above was neither done nor required in 70% of cases. In two-thirds of cases, the repair of the stomach/bowel perforation caused by the distal VPS catheter was not done and it healed after the removal of the distal shunt catheter from the stomach/bowel.

Research perspectives

This systematic review revealed that the intra-gastric migration of the peritoneal end of a VPS catheter was more commonly reported in children than adults and older people. Intra-gastric migration with peroral extrusion of the distal VPS catheter was twice as commonly reported than the intra-gastric migration of the distal VPS catheter clinically presented without peroral extrusion. A high degree of clinical suspicion is required for the diagnosis of cases of an intra-gastric migration of the distal VPS catheter clinically presenting without trans-oral extrusion. The exact mechanism for the intra-gastric migration of the peritoneal end of the VPS catheter is not known and requires some specific experimental studies.