Migration of a ventriculoperitoneal shunt catheter through the processus vaginalis in infants: how serious inguinal hernia and hydrocele might be

Inguinal Hernia in Premature Infants

Inguinal hernia is a common problem affecting infants in the NICU. As a group, preterm infants have the highest incidence of inguinal hernia and this risk increases as gestational age decreases. The etiopathologic factors leading to the development of an inguinal hernia are not clear and interventions to alter these factors have not been thoroughly investigated. Diagnosis of an inguinal hernia is often straightforward, but occasionally it may be difficult to determine if the hernia is strangulated or simply obstructed. Rarely, investigative modalities, such as ultrasonography, may be needed to rule out other potential causes. The ideal timing of surgical repair in this population is unknown and complicated by comorbid conditions and limited randomized controlled trials. During surgery, the choice of regional versus general anesthesia requires a team-based approach and studies have found that greater clinical experience is associated with lower morbidity. The techniques of hernia surgery range from open to laparoscopic repair and have been investigated in small prospective studies, while larger databases have been used to analyze outcomes retrospectively.

Inguinal Extrusion of a Ventriculoperitoneal Shunt

BACKGROUND

Complications of ventriculoperitoneal (VP) shunts include migration into various anatomic compartments and even extrusion through tissue layers.

CASE DESCRIPTION

A 31-year-old female patient with a VP shunt presented with distal shunt tubing extruding through the skin at the level of the inguinal ligament. Shunt hardware was removed, and cultures grew Dermacoccus. The patient was treated with broad-spectrum antibiotics and underwent placement of a lumboperitoneal shunt.

CONCLUSIONS

Dermacoccus is a gram-positive skin organism with rare human pathogenicity and not previously known to cause shunt infections.

Cerebrospinal fluid hydrocele caused by scrotal migration of a ventriculoperitoneal shunt

A 6-month-old boy presented with painless right hemiscrotal swelling. The scrotal ultrasound revealed a cerebrospinal fluid hydrocele caused by the migration of a ventriculoperitoneal shunt (VPS) catheter tip into the right hemiscrotum and associated undescended left testis. Earlier, he underwent a VPS placement for hydrocephalus secondary to neonatal bacterial meningitis and ventriculitis. The patient was treated with bilateral herniotomy, left-sided orchidopexy and repositioning of VPS into the peritoneal cavity.

Choroid Plexus Hyperplasia with Intractable Ascites and a Resulting Communicating Hydrocele following Shunt Operation for Hydrocephalus

Choroid plexus hyperplasia/papilloma and resulting hyperproduction of cerebrospinal fluid is a rare cause of hydrocephalus. In these patients, intractable ascites can occur after a ventriculoperitoneal (VP) shunting operation. However, shunt-related hydrocele is a rare complication of VP shunting. Previous reports have indicated catheter-tip migration to the scrotum as a cause of hydrocele. Here, we present the first documented case of choroid plexus hyperplasia that led to intractable ascites after shunting and a resulting hydrocele without catheter-tip migration into the scrotum.