Migration of a fractured ventriculoperitoneal shunt into the scrotum: a rare complication

Abstract

DESCRIPTIONChildren with hydrocephalus are commonly treated with a ventriculoperitoneal (VP) shunt for diversion of CSF. Unfortunately, complications arising from VP shunting are not uncommon. Apart from shunt blockage and infection, it may become disconnected or fractured and migrate into the potential spaces or viscera.Here we present images of a unique complication of VP shunt in a 14-year-old boy who had a background history of congenital hydrocephalus. At the age of 13 years, he had a fracture of the right VP shunt at the mid-cervical spine level ( figure 1A) with migration of the distal portion into the abdomen. Revision of the right VP shunt was done but the previously migrated distal tube was not removed from the abdomen as the patient had no abdominal symptoms. However, 7 months later he presented with a 3 day history of left scrotal swelling and fever. On examination, the left scrotum was red, swollen and tender, with a palpable foreign body within.The abdominal radiograph ( figure 1B) and scrotal ultrasound (figure 2) show the presence of the previously fractured distal portion of the VP shunt in the left scrotum. Intraoperatively, a patent narrow inguinal canal was detected paving the tract for the migration. Successful removal of the tube by left herniotomy was performed with an uneventful recovery.VP shunt fracture and migration into the scrotum is a very rare phenomenon.1 This complication tends to occur in younger children because of the higher incidence of an unobliterated processus vaginalis and smaller volume of the peritoneal cavity.1 Figure 1 Images of the frontal (A) neck/chest and (B) abdominal radiographs. The neck/chest radiograph demonstrates the initial site of the fractured right ventriculoperitoneal (VP) shunt at the upper cervical region (arrowhead). The abdominal radiograph was taken 7 months later after the revision. The coiled distal portion of right VP shunt had migrated into the left scrotum (curved arrow). The tip of the right shunt was seen in the lower abdomen (black arrow) while the tip of the left shunt was seen in the left upper abdomen (white arrow). There was no evidence of intestinal obstruction. Right hip dislocation was also seen.

Needle in a haystack: migration of ventriculoperitoneal shunt into scrotum of infant

“…The issue of the length of peritoneal catheter and complications related to it has been discussed in the literature and suggests that use of full-length peritoneal shunt catheter is not associated with an increase in complications and eliminates the need to lengthen the peritoneal catheter for growth of the child [10,11].…”

“…After placement, however, complications are frequent, especially in children. Shunt migration through a patent processus vaginalis within the scrotal sac is a rare event, with only a few cases reported till date [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. We report a case of scrotal migration of VP shunt in a 1-year-old boy, through patent processus vaginalis, who had a background history of congenital hydrocephalus.…”

Cerebrospinal fluid hydrocele caused by scrotal migration of a ventriculoperitoneal shunt

“…However, the migration of VPS tip into the hernial sac is a rare event. Shahizon et al reported a case of scrotal mass formed by coiling of a fractured end of VPS migrating into the scrotum within the hernia sac 8. Lee et al reported a case of VPS migration into the scrotum of an adult male 9.…”

Migration of Ventriculoperitoneal Shunt into a Hernia Sac: An Unusual Complication of Ventriculoperitoneal Shunt Surgery in Children

“…Shunt migration within the hernia sac is an even rarer event. A fractured end of VP shunt tubing migrating to the scrotum within the hernia sac and coiling to form a scrotal mass has also been reported [2]. Lee et al [3] compiled data on cases where a VP shunt migrated into the inguinal hernia sac.…”