Ventriculoperitoneal Shunt Catheter Research Articles

Case Report: Ventriculoperitoneal Shunt Catheter Migration and Transanal Extrusion in Persistent Vegetative State Adult Patient

The complications of ventriculoperitoneal (VP) shunts are many and are reported in literature extensively. The complication of transanal extrusion after bowel perforation is known although rare. This complication is very well described amongst the children. The authors describe the case of bowel perforation and transanal extrusion of a VP shunt occurring in a 51-year-old adult patient. The patient has a history of craniotomy for acute subdural hematoma after severe head injury one year ago continued with VP shunt for post-traumatic hydrocephalus. Home care with bedridden conditions is done at home until finally, the family gets the catheter extrude from the transanal. Bowel perforation and transanal extrusion of VP shunt catheter is a rare but serious problem. The exact pathogenesis of shunt-related organ perforation and extrusion through the anus is unclear, and various mechanisms have been suggested, Among many factors, age is the prominent factor for bowel perforation.1 Because of weak bowel musculature and stronger peristaltic activity, children are more susceptible to bowel perforation than adult patients. In adult shunted patient, one of the risk factors is related to PVS with chronic immobilization, as described in this case. Risk factors of bowel perforation in adult are quite distinct from children. Persistent vegetative state (PVS) with chronic immobilization is one of the risk factors to be aware of.

Migration of Ventriculoperitoneal Shunt Catheter into the Scrotum: A Case Report and Literature Review

Introduction: The ventriculoperitoneal shunt is the most widely used surgical procedure for the treatment of hydrocephalus. It is associated with numerous mechanical complications, including distal catheter migration. Case report: We present a case in which the peritoneal catheter migrated into the scrotum. The patient was admitted with asymmetric scrotal swelling and, during hospitalization, developed shunt dysfunction and infection. The shunt was withdrawn and treatment was initiated for infection. At the end of treatment, a new shunt was implanted and bilateral hernioplasty was performed by the pediatric surgery team. At follow-up, there was adequate head circumference growth and no testicular abnormalities. Discussion: The procesus vaginalis is formed from the evagination of the peritoneum through the inguinal canal, leading to the descent of the testis during the embryonic period. The patency of this structure is the predisposing anatomical condition for the occurrence of inguinal hernia and for the migration of the shunt catheter into the scrotum. This condition is present in up to 80% of newborns and 60% of 1-year-old infants. The migration of the catheter commonly occurs until 12 months after surgery, typically on the right side. Conclusion: The presence of scrotal swelling in a patient with ventriculoperitoneal shunt should warrant the investigation of catheter migration.

Bowel perforation of ventriculoperitoneal shunt catheter: endoscopically treated two cases.

Many techniques were used for the treatment of hydrocephalus, and ventriculoperitoneal shunt surgery is a widely used procedure. Ventriculoperitoneal shunt surgery has been associated with several complications like obstruction of the tube, infection, cerebrospinal fluid loculation, intestinal obstruction, migration of the shunt, and perforation of the intestinal organs. Perforation of the bowel owing to protrusion of ventriculoperitoneal shunt catheter from the anus is an extremely rare complication. Mini or exploratory laparotomy and revision of peritoneal part of shunt and repair of bowel perforation, or pulling out the ventriculoperitoneal shunt catheter and using external ventricular drainage and antibiotics, or colonoscopic removal of ventriculoperitoneal shunt catheter and repair of the bowel can be performed. Retrograde contamination of cerebrospinal fluid and meningitis is a very important part of the treatment in these cases. We aimed to present two cases with bowel perforation who treated with endoscopically. We report the cases of 2 patients with transanal protrusion of VPS catheter and the management via endoscopic therapeutic options. Successful treatment of the patients was achieved by endoscopic removal of the catheter and endoscopic repair of the bowel perforation. If peritonitis, bowel obstruction, or abscess does not occur, endoscopic removal of shunt and bowel repairing with endoclips may be enough.

Ventriculostomy with subsequent ventriculoperitoneal shunt placement after subarachnoid hemorrhage: the effect of implantation site on postoperative complications-a single-center series.

Patients suffering from aneurysmal subarachnoid hemorrhage (SAH) with shunt-dependent hydrocephalus require subsequent placement of a ventriculoperitoneal shunt (VPS) after ventriculostomy. However, in patients with previous ventriculostomy, the site for proximal VPS catheter placement is still controversial. We investigated the effect of catheter placement on postoperative complications by analyzing patients with ventriculostomy and subsequent VPS placement after SAH. From January 2004 to December 2018, 164 of 1128 patients suffering from SAH underwent subsequent VPS placement after ventriculostomy in the authors' institution. Patients were divided into two groups according to the position of the ventriculostomy and the site of the proximal VPS catheter ("same site" group versus "contralateral site" group). VPS-related infectious and bleeding complications following VPS placement were assessed and analyzed. Overall, VPS-related infections occurred in 11 of the 164 patients (7%). Furthermore, five of the 164 patients (3%) suffered from VPS-related hemorrhage. However, VPS infection rate was lower 5% (6/115) in the same site compared to 10% (5/49) in the contralateral site group, although without reaching statistical significance (OR = 0.48 (0.14, 1.67) 95% confidence interval, p = 0.3). VPS-related hemorrhage rate did not differ significantly between patients in the same site group (3.5%, 4/115) and the contralateral site group (2.0%, 1/49; OR = 1.73 (0.18, 15.9), p = 1.0). Our study suggests that the use of the ventriculostomy site for VPS placement does not significantly increase the risk of either VPS-related infections or VPS-related hemorrhages.

Anatomical Classification for the Migration of the Distal Catheter of the Ventriculoperitoneal Shunt

There have been many reports on migration of the distal catheter of the Ventriculoperitoneal shunt (VPS) since this complication was recognized more than 50 years ago. However, there have been no attempts to analyze its different anatomical patterns and to assess the potential risk of these patterns to the patients. We comprehensively reviewed all reports of distal VPS catheter migration indexed in PubMed and were able to identify three different anatomical patterns of migration based on the catheter extension and the organs involved: (1) internal migration, when the catheter invades any viscus inside the thoracic, abdominal, or pelvic cavity; (2) external migration, when the catheter penetrates through the body wall either incompletely (subcutaneously) or completely (to outside of the body); and (3) compound migration, when the catheter penetrates a hollow viscus and then protrudes through a pre‐existing anatomical orifice. In addition, we analyzed the association between each migration type and several key factors, which could affect the incidence of this complication such as patient’s age, sex, shunt duration, and previous shunt revision. External migration occurred mostly in infants. In contrast, internal migration occurred mostly in adults. A body wall weakness was not a risk factor for catheter protrusion in external migration. Shunt duration was a very critical factor in the migration pattern, as most newly replaced shunts tended to migrate externally. Clinicians must pay close attention to cases of large bowel perforation by the catheter, since these cases were most often associated with intracranial infections. The organ involved in the compound type of migration could determine the route of extrusion, as the bowel was involved in all trans‐anal migrations and the stomach in most trans‐oral cases.

Minimally Invasive Removal of Retained Subcutaneous Ventriculoperitoneal Shunt Catheter Using an Endoscopic Vein Harvesting System: A Technical Note

Retained old cerebrospinal fluid diversion shunt catheters in the neck, chest, or abdominal walls are frequently encountered in patients with lifelong shunt-dependent hydrocephalus who have undergone multiple shunt revisions. Particularly in cases where years and decades go between shunt revisions, the distal catheter portion can get calcified and nearly impossible to remove. Most patients tolerate a retained shunt catheter without problems. In some patients, however, retained catheters can cause pain and discomfort, particularly over the clavicle with head movements. Albeit trivial, we are unaware of innovative solutions to this problem. Here, we describe the use of an endoscopic vein harvest device used in cardiothoracic surgery to completely remove an old, calcified shunt catheter. Removal of a calcified ventriculoperitoneal shunt catheter using an endoscopic vein harvesting system was performed in a 32-year-old man with shunt-dependent hydrocephalus from premature birth. At 14 years of age, the patient had his only shunt revision consisting of a new distal catheter being placed adjacent to the old catheter. The patient presented with significant discomfort from the retained original shunt catheter. Using the endoscopic vein harvesting system, the shunt catheter was removed minimally invasively and the patient had complete resolution of his symptomatology. The endoscopic vein harvesting system used in cardiothoracic surgery is a suitable instrument to remove long segments of a retained ventriculoperitoneal shunt catheter minimally invasively through a small skin incision. To our knowledge, this is the first report of minimally invasive removal of a retained ventriculoperitoneal catheter.

Spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child: a case report

BackgroundBowel perforation caused by the ventriculo-peritoneal shunt is a rare occurrence with an estimated incidence rate of 0.1% to 1.0% among all cases of VP shunt displacement. This is an unusual report of spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child. Literature was reviewed to find out therapeutic strategies.Case presentationAn asymptomatic 8 months old boy presented with spontaneous trans-anal extrusion of caudally migrated left-sided Chhabra type of ventriculo-peritoneal (VP) shunt for last 1 day, following surgery for hydrocephalus initially done 3 months ago. He had no features of peritonitis or encephalitis. Digital X-ray of the whole abdomen in postero-anterior view in erect posture was only evident of the expulsion of radio-opaque distal catheter tip through the anus into the exterior. Noncontrast-enhanced computed tomography scan (NCCT) of brain showed proximal catheter in the lateral ventricle of the brain. Under sedation, the distal part of the VP shunt catheter was resected out, aseptically, over the abdomen and pulled out gently through the anus. The proximal catheter part along with the reservoir was removed through a separate incision in the neck and sent for bacteriological study, which came out later to be negative. Postoperatively, the child was put on a prophylactic antibiotic and 3 weeks later another VP shunt was placed in the contralateral side.ConclusionsSpontaneous trans-anal extrusion of VP shunt tip is a surgical emergency. The whole catheter must be removed aseptically in such a way that both contamination of the cerebral cavity and spillage into the peritoneum can be avoided. Awareness of this unusual complication among surgeons is needed for early recognition, management, and timely intervention to minimize morbidity.

Case Report: Ventriculoperitoneal Shunt Catheter Migration and Transanal Extrusion in Persistent Vegetative State Adult Patient

The complications of ventriculoperitoneal (VP) shunts are many and are reported in literature extensively. The complication of transanal extrusion after bowel perforation is known although rare. This complication is very well described amongst the children. The authors describe the case of bowel perforation and transanal extrusion of a VP shunt occurring in a 51-year-old adult patient. The patient has a history of craniotomy for acute subdural hematoma after severe head injury one year ago continued with VP shunt for post-traumatic hydrocephalus. Home care with bedridden conditions is done at home until finally, the family gets the catheter extrude from the transanal. Bowel perforation and transanal extrusion of VP shunt catheter is a rare but serious problem. The exact pathogenesis of shunt-related organ perforation and extrusion through the anus is unclear, and various mechanisms have been suggested, Among many factors, age is the prominent factor for bowel perforation.1 Because of weak bowel musculature and stronger peristaltic activity, children are more susceptible to bowel perforation than adult patients. In adult shunted patient, one of the risk factors is related to PVS with chronic immobilization, as described in this case. Risk factors of bowel perforation in adult are quite distinct from children. Persistent vegetative state (PVS) with chronic immobilization is one of the risk factors to be aware of.

1930 Ventriculoperitoneal Shunt Migration Into the Stomach: Case Report and Review of Literature

INTRODUCTION: Complications of ventriculoperitoneal (VP) shunting includes shunt migration, meningitis, peritonitis and peritoneal pseudocyst. Bowel perforation following VP shunt placement is rare, occurring in about 0.01 to 0.03% with the colon being the most common site. We report a case of migration of a VP shunt catheter into the stomach, in a patient who presented with iron deficiency anemia. CASE DESCRIPTION/METHODS: A 65-year-old African-American woman was referred to gastroenterology clinic for iron deficiency anemia. She had no gastrointestinal symptoms and fecal immunochemical test was negative. Colonoscopy was unremarkable. EGD showed no evidence of peptic ulcer disease or any arteriovenous malformation up until the fourth part of duodenum. A foreign body protruding into the gastric fundus [Figure 1] was noted. On review of her PMH, she had a VP shunt procedure in 1995 after clipping of an intracranial aneurysm. CT of abdomen confirmed the presence of the VP shunt in the stomach [Figure 2]. The patient was referred to General Surgery for laparoscopy. During surgery, approximately five-six cm of the distal tip of the VP shunt was intragastric, forming a fistula between the stomach and the abdominal wall. The fistula was sealed, and the shunt was repositioned intraperitoneally. The patient was stable after the surgery. DISCUSSION: From a review of the literature, our patient’s presentation with iron deficiency anemia and no gastrointestinal symptoms was unusual. Only 16 cases of intragastric migration of a peritoneal catheter have been previously described. Most patients complained of abdominal discomfort prior to the intragastric perforation. This complication predominantly affects children . The mean interval between the last shunt procedure and perforation was approximately 48.3 months (1 day to 23 yrs) and is unpredictable. The possible mechanisms of bowel perforation includes catheter adherence causing a local inflammation resulting in fibrosis or the continuous pressure from the catheter tip leading to erosion of the bowel and delayed perforation. Our patient could also have had chronic gastric bleeding which may have contributed to her iron deficiency anemia. Treatment approaches include injection of fibrin glue to close the perforated stomach wall, and direct suture of the stomach wall by laparotomy. In our patient, the latter approach was taken. To our knowledge, this is the only reported case of a patient with intragastric migration of a VP shunt presenting with iron deficiency anemia.

Bladder Perforation of a Ventriculoperitoneal Shunt Catheter: Case Report and Literature Review

Bladder Perforation of a Ventriculoperitoneal Shunt Catheter: Case Report and Literature Review

Safety of laparoscopic colorectal surgery in patients with ventriculoperitoneal shunt.

This study retrospectively investigated the safety of laparoscopic colorectal surgery in patients with ventriculoperitoneal shunt (VPS) based on the experiences within our department. A total of 866 patients underwent laparoscopic colorectal surgery for colorectal cancer, ulcerative colitis, Crohn's disease, and acute appendicitis at Osaka University during the study period. Laparoscopic colorectal surgery cases were collected from the Osaka University database. Among them, four (0.5%) had VPS when they underwent surgery. In these four cases, we consulted a neurosurgeon and checked the route of the VPS catheter to determine whether it had a unidirectional valve to prevent backflow and whether it was working normally. We retrospectively investigated the clinical characteristics of these four cases. All cases were safely treated, with the pneumoperitoneum pressure set at 10 mmHg under routine anesthetic monitoring and without any manipulations such as clamping or externalization of the VPS catheter. The four patients were discharged without any VPS-related complications such as increased intracranial pressure, shunt failure, or infection. Our study suggests that laparoscopic colorectal surgeries in patients with VPS without any manipulations may be safe. Future studies should aim to better standardize the perioperative management of VPS during laparoscopic colorectal surgery.

Ventriculo Peritoneal shunt catheter penetrating the Kidney: An unusual complication of shunt surgery

Ventriculo Peritoneal (VP) shunt surgery is one of the commonly performed neurosurgical procedure in the management of hydrocephalus. Numerous complications related to this procedure are reported in the literature. Shunt malfunction related to the abdominal catheter is seen nearly 10-40% of cases. The catheter can perforate hollow viscous or solid organs. Among the solid organs, the kidney penetration was not reported in the English literature. We report an unusual case of VP shunt abdominal catheter migration in to kidney Ventriculo peritoneal shunt being one of the commonest procedures done by any neurosurgeon has many complications. Among them abdominal catheter complications like halo viscous perforation, abdominal wall perforation and extrusion through the natural orifices are considered to be rare. Solid organ perforations are very unusual and very limited numbers of these are reported.Nepal Journal of Neuroscience 15:27-28, 2018

Pleural effusion from intrathoracic migration of a ventriculo-peritoneal shunt catheter: pediatric case report and review of the literature

BackgroundPleural effusion is a rare complication of ventriculo-peritoneal (VP) cerebrospinal fluid (CSF) shunting and its diagnosis is difficult in patients with neurological and consciousness impairment.Case reportHerein we report the case of a child affected by Pfeiffer syndrome and hydrocephalus, shunted at the age of 3 months, who developed acute respiratory failure due to a right-sided pleural effusion 2 years later. Plain chest radiographs and computed tomography (CT) showed the intrathoracic migration of the right VP shunt abdominal tip. Beta-2 transferrin, a marker for CSF, was found in the pleural fluid and the hypothesis of a CSF hydrothorax was confirmed. Effusion was treated with a thoracentesis. Seven days after, the right VP shunt was revised; a ventriculo-atrial (VA) shunt was also placed on the left side to serve as the main CSF shunt and to prevent the recurrence of hydrothorax. We review the pediatric cases of CSF hydrothorax reported in the literature and discuss the mechanisms underlying this complication together with the possible treatments.ConclusionPleural effusion due to VP shunt insertion is a rare and potentially life-threatening condition that should be suspected in any patient with a VP shunt and respiratory failure. Signs of hydrothorax may moreover represent the only clinical evidence of a shunt-related complication in case of neurologically severely compromised patients in which neurologic examination cannot help to make a diagnosis.

Ileal Obstruction secondary to Strangulation of the Ventriculoperitoneal Shunt Catheter

Ileal Obstruction secondary to Strangulation of the Ventriculoperitoneal Shunt Catheter

Laparoscopic management of pediatric and adolescent patients with intra-abdominal complications of ventriculoperitoneal shunt

Background/purpose: Ventriculoperitoneal (VP) shunt is the most common operative procedure performed in the treatment of hydrocephalus. The aim of this procedure is to drain CSF from the ventricles to the peritoneal cavity, thus to decrease the intracranial pressure. Numerous complications as a result of this technique are reported in the literature and are most commonly located around the peritoneal end of the shunt tube. The standard approach for management is laparotomy and correction of the complication. This approach, although solves the problem, causes the formation of adhesions, which are also not devoid of consequences. The aim of this study is to present our experience and outline the role of laparoscopy in the management of intraabdominal complications of VP shunt in pediatric and adolescent patients. Patients and Methods: Over a period of 4 years, 14 patients were managed and recruited in this study. All patients were presented with recurrent abdominal signs and symptoms or elevated intracranial pressure. All patients were managed laparoscopically according to the final diagnosis. Results: Fourteen patients (9 men and 5 women) with abdominal complications of VP shunt catheter were managed. Their ages at operation were ranged from 10 months to 15 years. All patients were investigated, diagnosed and managed laporoscopically. The median operative time of the laparoscopic procedure varied according to the diagnosis. It was 120 minutes in pseudocysts, 45 minutes in recurrent congenital inguinal hernias, 100 minutes in adhesive intestinal obstruction and 35 minutes in subcutaneous cyst and 30 minutes in umbilical fistula. Follow up period extended for 24 months after the procedure and all patients had complete resolution of their presenting abdominal or neurological symptoms. The length of the postoperative hospital stay ranged from one day in recurrent congenital hernias up to 4 days in the other procedures. There were no intra- or postoperative complications related to the laparoscopic technique. Conclusion: Laparoscopic is a very useful diagnostic and therapeutic tool in dealing with intra-abdominal complications of VP shunt with high safety and an excellent outcome. Keywords: hydrocephalus, laparoscopic management, ventriculoperitoneal shunt

Cholangiocarcinoma Seeding along a Ventriculoperitoneal Shunt Catheter: A Rare Initial Manifestation

AbstractCholangiocarcinoma accounts for less than 2% of all malignant neoplasms. Its cutaneous metastases are extremely rare, accounting for 0.0002% of all cases. The ventriculoperitoneal (VP) shunt has been considered a potential route for tumor dissemination. This type of tumor proliferation has been well documented in patients with intra-abdominal metastases secondary to brain tumors and, less frequently, brain metastases secondary to intra-abdominal tumors. In spite of that, there are few reports of cutaneous metastases along the VP shunt catheter trajectory.We present the case of a cholangiocarcinoma cutaneous metastasis at the VP shunt trajectory as the first clinical sign of this type of tumor. The patient had undergone the shunt insertion 4 years earlier due to a hydrocephaly secondary to a subarachnoid hemorrhage. After diagnosis, she was referred to chemotherapy and oncology follow-up.In the literature, 30 cases of cutaneous metastasis of cholangiocarcinoma were reported. Dissemination has been described involving percutaneous biliary drainage and distant sites. However, the case presented in this study alerts us about the possibility of cutaneous metastasis of intra-abdominal tumors in the trajectory of VP shunt catheters.

Endovascular Retrieval of Migrated Distal End of Ventriculoperitoneal Shunt from Bilateral Pulmonary Arteries: A Technical Note

Ventriculoperitoneal (VP) shunting of cerebrospinal fluid is one of the most common procedures performed by neurosurgeons around the world. Migration of distal VP shunt catheter into bilateral segmental pulmonary arteries is an extremely rare complication of VP shunt placement. In the present case, a 30-year-old male underwent VP shunting complicated by migration of distal VP shunt catheter into the bilateral pulmonary arteries. Despite manual attempt at externalizing the distal VP shunt catheter at the level of the clavicle, a small piece of distal VP shunt catheter in bilateral pulmonary arteries was noted on computed tomography of the chest obtained after manual externalization. This persistent distal VP shunt catheter was likely left behind after a break in the distal VP shunt catheter during manual externalization procedure. Given the small size of the segmental pulmonary arteries, a novel endovascular technique was used to move the distal VP shunt catheter from the bilateral segmental pulmonary arteries to the main pulmonary trunk. Once in the main pulmonary trunk, a snare device was used to retrieve the distal shunt catheter through the femoral vein. In this technical note, the authors highlight the relevant endovascular technical details to first move the VP shunt catheter from the bilateral segmental arteries followed by successful catheter retrieval using snare device.

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: A Comprehensive Analytical Review from an Anatomical Perspective.

There have been many reports on migration of the distal catheter of the ventriculoperitoneal shunt (VPS) since this phenomenon was recognized 50 years ago. However, there have been no attempts to analyze its different patterns or to assess these patterns in terms of potential risk to patients. We comprehensively reviewed all reports of distal VPS catheter migration indexed in PubMed and identified three different anatomical patterns of migration based on catheter extension and organs involved: (1) internal, when the catheter invades any viscus inside the thoracic, abdominal, or pelvic cavity; (2) external, when the catheter penetrates through the body wall either incompletely (subcutaneously) or completely (outside the body); and (3) compound, when the catheter penetrates a hollow viscus and protrudes through a pre-existing anatomical orifice. We also analyzed the association between each migration type and several key factors. External migration occurred mostly in infants. In contrast, internal migration occurred mostly in adults. A body wall weakness was not a risk factor for catheter protrusion. Shunt duration was a critical factor in the migration pattern, as most newly-replaced shunts tended to migrate externally. Clinicians must pay close attention to cases of large bowel perforation, since they were most often associated with intracranial infections. The organ involved in compound migration could determine the route of extrusion, as the bowel was involved in all trans-anal migrations and the stomach in most trans-oral cases. Clin. Anat. 30:821-830, 2017. © 2017Wiley Periodicals, Inc.

Migration of a ventriculoperitoneal shunt catheter through the processus vaginalis in infants: how serious inguinal hernia and hydrocele might be.

Migration of the catheter tip of a ventriculoperitoneal shunt (VPS) through a patent processus vaginalis (PV) has seldom being reported. In this series, we analyzed all cases of inguinoscrotal migration of an VPS catheter at our center. Between 1975 and 2015, 295 VPS insertions were performed. In seven infants (2.3%), migration of the catheter through a patent PV was demonstrated. Cases with hydroceles had associated VPS malfunction, but cases with hernias were not associated with it. The current recommendation is to delay a PV closure until 2years of age in cases of infants with hydrocele without further radiological examinations, but this might not be the case in infants with VPS.

Extrusion of Peritoneal end of Ventriculoperitoneal Shunt Catheter from Scalp Wound: A Case Report

Ventriculo Peritoneal Shunt (VPS) implantation for hydrocephalus is associated with several complications. Proximal migration of the VPS catheter is a rare complication following ventriculo-peritoneal shunting. This is a report of a management of 8-month-old-boy who had extrusion of peritoneal end of VPS catheter through scalp wound. VPS was placed at the age of 4-month for congenital / obstructive hydrocephalus. One and half month after VPS placement, he had redness and subcutaneous fluid collections around the VPS catheter tract at neck and chest area and were treated well with oral antibiotics. Four months after the shunt implantation, he was admitted with a complaint of that the end of peritoneal catheter was extruding out through scalp wound. He was managed well with removal of entire VPS tubing through scalp incision, injectable antibiotics, and delayed re-VPS placement on right side. Three-week after shunt revision, he again presented with extrusion of part of peritoneal catheter from neck area and was managed with removal of peritoneal catheter, and ventricular catheter was used as external ventricular drainage (EVD). His Computed Tomography (CT) scan of head showed dilatation of lateral ventricles (more on right side) and therefore right sided VPS was placed again after a month. Extrusion of distal / peritoneal end of VPS catheter from scalp is unique and probably not reported earlier.