A rare case of Ventriculoperitoneal Shunt (VPS) End Catheter Thorax Migration in an Infant Patient with Diaphragmatic Congenital Defect

Hydrocephalus secondary to ventriculoperitoneal shunt (VPS) malfunction represents a frequent complication in the pediatric population, with catheter migration accounting for a minority of cases. Thoracic migration of the distal VPS catheter is an exceptionally rare event and poses significant diagnostic and therapeutic challenges due to the potential risk of respiratory compromise, infection, and secondary intracranial hypertension. We report the case of a 2-year-old male infant with a history of neonatal hydrocephalus secondary to meningitis, previously treated with VPS placement, who presented with refractory bronchopneumonia, signs of increased intracranial pressure, and shunt dysfunction. Imaging studies revealed hypertensive hydrocephalus and intrathoracic migration of the distal shunt catheter through a congenital diaphragmatic defect. Surgical exploration via laparotomy confirmed catheter transdiaphragmatic migration, allowing safe removal and replacement of the VPS under direct visualization. Postoperatively, the patient showed clinical improvement with resolution of respiratory infection and no new neurological deficits. This case highlights a rare but severe complication of VPS placement and emphasizes the importance of considering anatomical congenital anomalies in the evaluation and management of shunt malfunction in pediatric patients.