Abstract
Objective
The incidence of scrotal migration of a ventriculoperitoneal shunt (VPS) catheter is rare and may lead to life-threatening visceral complications. Management requires prompt removal of the migrated portion of the shunt and closure of the scrotal sac. We report an interesting case of a young child who presented with asymptomatic unilateral swelling of his scrotum secondary to a migrated VPS catheter. A repeat X-ray prior to his surgery to remove the migrated catheter showed that the entire length of the distal VPS catheter was back in the peritoneal cavity. In view of this unusual phenomenon, the case is discussed in corroboration with published literature.
Methods and results
A systematic search of publications in the English language is performed in PubMed and Google Scholar. Our findings show that there are 49 reported cases (including our patient) of scrotal migration of shunt catheters in patients less than 18 years old. There is only 1 other case of spontaneous resolution of shunt catheter from the scrotum. Favoured management of choice is repositioning the distal shunt catheter back into the peritoneal cavity and herniotomy in the same setting, if possible. Overall, the literature suggests this is a shunt-related complication that has a good prognosis if intervention is timely.
Conclusion
Scrotal migration of a VPS catheter is a rare but potentially life-threatening complication in children. Our case report highlights the role of updated preoperative imaging and the need for consistent long-term shunt surveillance in children.
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References
Low SYY, Kestle JRW, Walker ML, Seow WT (2023) Cerebrospinal fluid shunt malfunctions: a reflective review. Childs Nerv Syst. https://doi.org/10.1007/s00381-023-06070-4. (Epub ahead of print. PMID: 37462810)
Lim JX, Han HP, Foo YW, Chan YH, Ng LP, Low DCY, Seow WT, Low SYY (2023) Paediatric ventriculoperitoneal shunt failures: 12-year experience from a Singapore children’s hospital. Childs Nerv Syst. https://doi.org/10.1007/s00381-023-06007-x. (Epub ahead of print. PMID: 37284980)
Hauser T, Auer C, Ludwiczek J, Senker W, Rauch PR, Kargl S, Gruber A (2021) Treatment options for scrotal migration of ventriculoperitoneal shunts: case illustration and systematic review of 48 cases. Oper Neurosurg 21:87–93
Nejat F (2018) Scrotal complications of ventriculoperitoneal shunt. Asian J Neurosurg 13:197
Crofford MJ, Balsam D (1983) Scrotal migration of ventriculoperitoneal shunts. AJR Am J Roentgenol 141:369–371
Kraemer MR, Sandoval-Garcia C, Bragg T, Iskandar BJ (2017) Shunt-dependent hydrocephalus: management style among members of the American Society of Pediatric Neurosurgeons. J Neurosurg Pediatr 20:216–224
Stein SC, Guo W (2008) Have we made progress in preventing shunt failure? A critical analysis. J Neurosurg Pediatr 1:40–47
Chanchlani R, Sharma PK, Gunasekaran V, Kasundra A (2023) Scrotal migration of peritoneal end of ventriculoperitoneal shunt in an infant - a rare entity. J Neurosci Rural Pract 14:365–367
Kita D, Hayashi Y, Kinoshita M, Ohama K, Hamada J (2010) Scrotal migration of the peritoneal catheter of a ventriculoperitoneal shunt in a 5-year-old male. Case report. Neurol Med Chir (Tokyo) 50:1122–1125
Brainwood M, Beirne G, Fenech M (2020) Persistence of the processus vaginalis and its related disorders. Australas J Ultrasound Med 23:22–29
Topp G, Entezami P, Ambati S, Szewczyk B, Adamo MA (2023) Cerebrospinal fluid leakage from scrotum secondary to ventriculoperitoneal shunt migration. Asian J Neurosurg 18:333–335
Rehm A, Bannister CM, Victoratos G (1997) Scrotal perforation by a ventriculoperitoneal shunt. Br J Neurosurg 11:443–444
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34
Acer-Demir T, Ekenci BY, Özer D, Turanoğlu MA, Haberal KC, Bilgin EB, Hiçsönmez A (2018) Natural history and conservative treatment outcomes for hydroceles: a retrospective review of one center’s experience. Urology 112:155–160
Jacob S (2008) Chapter 4 - Abdomen. In: Jacob S (ed) Human Anatomy. Churchill Livingstone, pp 71–123
Oktem IS, Akdemir H, Koç K, Menkü A, Tucer B, Selçuklu A, Turan C (1998) Migration of abdominal catheter of ventriculoperitoneal shunt into the scrotum. Acta Neurochir (Wien) 140:167–170
Bawa M, Garge S, Garg R, Narasimha Rao KL (2017) Scrotal migration of tubing: an unusual complication after ventriculo-peritoneal shunt. Asian J Neurosurg 12:738–740
Alkhudari A, Galal M, Wagley Z, Sabbah BN, Houdane A, Aljabr A (2022) A case of spontaneous resolution of a scrotal ventriculoperitoneal shunt migration. Radiol Case Rep 17:3620–3623
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All authors have read and approved the manuscript. Conceptualization: YW and SYYL. Data curation: YC, LPN and SYYL. Formal analysis: YC and SYYL. Investigation: YW, LPN, SYYL. Methodology: SYYL. Project administration: YW, YC and LPN. Resources: SYYL. Validation: SYYL. Writing – original draft: YW, SYYL. Writing – review & editing: SYYL.
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Wu, Y., Chen, Y., Ng, L.P. et al. Spontaneous regression of migrated ventriculoperitoneal shunt catheter from scrotum to peritoneum: a case-based review. Childs Nerv Syst 40, 19–25 (2024). https://doi.org/10.1007/s00381-023-06192-9
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DOI: https://doi.org/10.1007/s00381-023-06192-9