Abstract
BACKGROUND: Distal bowel perforation by peritoneal catheter (BPPC) is a rare complication following ventriculoperitoneal shunt (VPS) placement for the treatment of hydrocephalus. In some cases, BPPC may present with extrusion through the anus and can occur years after VPS placement. OBSERVATIONS: The authors report the case of a 30-year-old woman who had a VPS placed 8 years prior and found a catheter protruding from her rectum. Having pulled out 1 foot of catheter, she presented to the hospital where the shunt was externalized before concurrent VPS removal and laparotomy to repair the bowel perforation. LESSONS: BPPC with anal extrusion is a rare complication of VPS that can occur years after shunt placement and can present with a broad array of symptoms. BPPC should remain on the differential for people with VPS and systemic symptoms for the duration of their lives. https://thejns.org/doi/10.3171/CASE25365.