Scrotal migration of tubing: An unusual complication after ventriculo-peritoneal shunt

Abstract

Scrotal migration of peritoneal end of ventriculo-peritoneal (VP) shunt into the patent processus vaginalis (PPV) is a rare complication. Its exact incidence is not mentioned in the literature till date. This may be because of the rarity of this complication, and also because all previous articles related to the complication were case reports. We, in our series, had an incidence of 0.9%. This prospective study has been conducted on 437 patients in the age group of 1 month–3 years who underwent VP shunt for hydrocephalus over a period of 5 years from 2007 to 2011. The incidence of a hernia manifesting after shunt insertion has been reported to be around 16.8%. The average age of patients at the time of insertion of the shunt was 27.25 months (3–48 months). All our patients presented with swollen right sided scrotum after an average of 4 months (3–5 months) after shunt insertion. Shunt migration was more common on the right which is consistent with the incidence of hernias in children. The proper management of such cases includes repositioning of the catheter with the proper closure of the PPV. Usually, shunt revision is not required. We discuss the etiology, treatment and preventive measures of this rare entity.

Scrotal migration of a ventriculoperitoneal shunt

“…The incidence of a hernia manifesting after shunt insertion has been reported to be 16.8 per cent, and predominantly involves the right side. 6 This is consistent with the general paediatric population in which 60 per cent of hernias also occur on the right due to the later 2 A persistent PV (PPV), along with its more vertically oriented canal during infancy, increases the risk of congenital hydrocele, with a peak incidence of 30 per cent during the first 2 months of life, then falling sharply to 10 per cent by the end of the first year. 11 The same anatomical factors might also predispose shunted infant patients to distal catheter herniation into the scrotal sac.…”

“…It is well known that male paediatric patients with VP shunts have an increased risk of hernia and hydrocele when compared with normal children, but in the most extreme cases, shunt hardware can migrate into the scrotum. The incidence of a hernia manifesting after shunt insertion has been reported to be 16.8 per cent, and predominantly involves the right side . This is consistent with the general paediatric population in which 60 per cent of hernias also occur on the right due to the later descent of the right testis with subsequent delayed obliteration of the PV.…”

Postsurgical Complications after Spine Surgery

“…The treatment can be conservative, based on respiratory rehabilitation, or surgical. There is not consensus as to which is the most appropriate [6,7].…”

Shunt Migration into Scrotum: A Case Report

“…16 Increased intraabdominal pressure stops the closing of processus vaginalis and later this helps in shunt herniation. 17 It is also reported that scrotal shunt migration has an association with the formation of hernias in children (right -60%, left -30%, bilateral -10%). 5 The residual peritoneal volume is linearly correlated with the body surface area at approximately 80 ml/m 2 .…”