From ventricle to stoma: a rare case of ventriculoperitoneal shunt extrusion through a colostomy.

Ventriculoperitoneal shunts are the most common treatment for hydrocephalus but carry rare, potentially life-threatening complications, including bowel perforation. Transmural erosion may occur insidiously without peritonitis due to gradual migration and fibrotic encapsulation, making diagnosis challenging. We report a rare case of transcolonic VP shunt migration with extrusion through a colostomy in a 40-year-old man with spina bifida and a hostile abdominal surgical history. He presented with distal catheter protrusion from his stoma and cerebrospinal fluid drainage into the ostomy appliance. Imaging revealed dense calcification along the shunt tract with proper positioning intracranially. Cerebrospinal fluid cultures grew Pseudomonas and vancomycin-resistant Enterococcus faecium, requiring culture-directed antimicrobial therapy. Management required multidisciplinary coordination, including emergent shunt externalization, external ventricular drain placement, exploratory laparotomy with adhesiolysis, colotomy repair, and partial hardware removal. This case underscores the extreme rarity and complexity of enteric shunt perforation and the importance of coordinated medical and surgical care.