Delayed Umbilical Extrusion of a Ventriculoperitoneal Shunt Following Robotic-Assisted Laparoscopic Hysterectomy: A Case Report.

Ventriculoperitoneal shunts (VPSs) are the standard treatment for hydrocephalus but are associated with significant long-term complications, including distal catheter migration. Umbilical extrusion is an exceptionally rare manifestation, particularly in adults, and has seldom been described following minimally invasive gynecologic surgery. We report the case of a 35-year-old female patient with a VPS placed in early childhood who presented with persistent serous drainage from a prior umbilical port site four months after a robotic-assisted laparoscopic hysterectomy. Initial imaging demonstrated an intra-abdominal distal catheter without extrusion. Over time, the patient developed an extrusion of the catheter through the umbilicus. Abdominal CT confirmed distal migration through the anterior abdominal wall, while head CT showed no hydrocephalus. The patient remained neurologically intact. Surgical management included staged removal of the distal catheter and subsequent removal of the remaining components due to local infection, resulting in complete clinical recovery. Umbilical extrusion of a VPS catheter is among the rarest reported complications, with most cases occurring in pediatric populations. In this case, prior laparoscopic surgery may have contributed by altering intra-abdominal pressure dynamics, disrupting tissue planes, and weakening fascial integrity at port sites, thereby facilitating catheter extrusion. The prolonged latency highlights the lifelong risk of VPS-related complications and suggests that previously stable catheters may become susceptible to extrusion following abdominal interventions. Persistent postoperative umbilical drainage in patients with VPS should prompt evaluation for catheter extrusion. Awareness of this rare complication is essential for surgeons performing laparoscopic procedures in patients with indwelling shunts. Multidisciplinary management and appropriate perioperative planning are critical to optimize outcomes.