Hydrocele of the canal of Nuck as a result of a rare ventriculoperitoneal shunt complication

Encysted hydrocele of the canal of Nuck in an 11-month-old child with a past history of duodenal atresia and Arnold-Chiari malformation: A case report

RATIONALE

Hydrocele of the canal of Nuck is a rare developmental disorder and represents of a homolog of hydrocele of spermatic cord in males. Hydrocele of the canal of Nuck is a very rare cause of inguinal swelling in female infants and children. It results from the failure of obliteration of the distal portion of evaginated parietal peritoneum within the inguinal canal, which forms a sac containing fluid.

PATIENT CONCERNS

We describe a case of hydrocele of the canal of Nuck in an 11-month-old girl with a past medical history of duodenal atresia and Arnold-Chiari malformation.

DIAGNOSIS

Physical examination and ultrasound revealed a soft, cystic, noncompressible, and non-fluctuant labial mass measuring approximately 5 cm.

INTERVENTIONS

The patient underwent surgical exploration through a right skin crease incision. The cystic lesion was histologically confirmed to be a non-communicated hydrocele of canal of Nuck.

OUTCOMES

The child is doing well at 1-year follow-up with no swelling or recurrence on the operated side.

LESSONS

Hydrocele of the canal of Nuck is a rare developmental disorder but should be considered in a differential diagnosis in young girls with an inguino-labial swelling.

Rare complication of ventriculoperitoneal shunt. Early onset of distal catheter migration into scrotum in an adult male: Case report and literature review

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Cases of scrotal migration of distal catheter in adults are rare.

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There have been no reports for scrotal migration in adults at an early onset.

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Early detection of migration of distal catheter prevents shunt malfunction.

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Prompt surgical management of catheter repositioning is recommended.

Introduction

The role of shunt placement is to divert cerebrospinal fluid from within the ventricles to an alternative location in the setting of hydrocephalus. One of the rare shunt complications is distal catheter migration, and various body sites have been reported, including the scrotum. Although cases of scrotal migration of distal catheter have been reported in pediatric patients, cases in adult patients are rare due to obliterated processus vaginalis. Furthermore, there has not been a case reported for scrotal migration in an adult at an early onset.

Presentation of case

65-year-old male underwent shunt placement for normal-pressure hydrocephalus-like symptoms. On post-operative day seven patient developed right testicular edema, for which ultrasound was performed, revealing hydrocele along with the presence of distal catheter in the scrotum. On post-operative day nine patient underwent distal catheter trimming via laparoscopic approach with general surgery, with post-operative imaging showing satisfactory location of distal catheter in the peritoneal cavity.

Discussion/Conclusion

Early onset of distal catheter migration into scrotum in an adult male is a unique case, as most cases are reported in pediatric patients, and it is the first case reported in the English literature to have occurrence at an early onset during the peri-operative period. As our case demonstrates, early occurrence and detection of scrotal migration of the distal catheter prevent shunt malfunction. Prompt surgical management of catheter repositioning is therefore recommended to avoid the risk of further complications.

Ventricular peritoneal shunt malfunction after operative correction of scoliosis: report of three cases

BACKGROUND CONTEXT

Two of the most common disease processes associated with hydrocephalus in children are spina bifida and intraventricular hemorrhage of prematurity, both of which are known to be also associated with spinal deformity in later childhood. The occurrence of shunt malfunction after mechanical injury or stress to the hardware has been well documented. Newer techniques in the treatment of neuromuscular scoliosis, including anterior release with segmental fixation, have resulted in more powerful corrections of these large spinal deformities. A new potential cause of shunt malfunction is the aggressive correction of scoliosis.

PURPOSE

To report patients with neuromuscular curves averaging 100° who were subsequently recognized to have perioperative shunt malfunction.

STUDY DESIGN

Three case studies from a university hospital setting were included.

PATIENT SAMPLE

All three children were young adolescents and had-long term shunts. Two of the children had spina bifida and a third had cerebral palsy. All children underwent anterior release of their scoliosis with posterior segmental instrumentation, with unit rods and sublaminar wires. All had significant correction of their scoliosis.

OUTCOME MEASURES

Malfunctioning of the ventriculoperitoneal shunts were recorded.

METHODS

Chart reviews of three cases were analyzed.

RESULTS

Two children had shunt malfunctions within a month of their surgery, and one child had intraoperative recognition and externalization of the shunt.

CONCLUSIONS

Older children undergoing repair of neuromuscular scoliosis are often preadolescents or adolescents who have the same indwelling shunt systems originally implanted in early infancy. The shunt may be brittle and calcified, and the peritoneal catheter may be short. The correction of scoliosis often results in an almost instantaneous growth of a few inches. Because of the potential difficulty in recognizing shunt malfunction in the perioperative period, consideration should be given for elective revision of the peritoneal catheter in children at risk.

Bladder calculus formation on the tip of a migrated disused ventriculoperitoneal shunt

Bladder stones in children are rare. They generally occur in children with one or more predisposing risk factors to stone formation. In this unique case report we discuss the formation and successful endoscopic treatment of a large stone in a neuropathic bladder on the tip of a migrated VP shunt.

Younger boys have a higher risk of inguinal hernia after ventriculo-peritoneal shunt: a 13-year nationwide cohort study

BACKGROUND

Few studies associate ventriculo-peritoneal shunt (VPS) in children with higher incidence of inguinal hernia (IH). These institutional-based data have small numbers and provided little information about the effects of age and sex. This study aims to examine the incidences and risk factors of IH in children with hydrocephalus treated with VPS.

STUDY DESIGN

Using a 13-year nationwide database, a cohort of 1,568 children younger than 5 years of age who received VPS were followed up for IH. Of these, 194 received IH repair. Kaplan-Meier analysis and Cox regression were conducted.

RESULTS

Overall incidence of IH after VPS in children younger than 5 years old was 22.9 per 1,000 person-years. The average follow-up time was 5.41 years, and the mean time interval between VPS and IH repair was 1.14 years. Age-specific incidences were 45.0, 21.3, 18.5, and 4.1 per 1000 person-years for neonates, infants, toddlers, and preschool children, respectively. Compared with preschool children, neonates, infants, and toddlers, were more likely to have IH (crude hazard ratio = 9.8, 5.3, and 4.4; p < 0.001, p = 0.001, and p = 0.006, respectively). Sex and age were significantly different in children with and without IH (both, p < 0.001). Differences of cumulative incidence rates in the 4 age groups were significant in both male and female patients (p < 0.001 and p = 0.023, respectively).

CONCLUSIONS

The patient's age on VPS surgery significantly affects the likelihood of subsequent IH development. IH is more likely to develop in neonates after VPS than in infants, toddlers, and preschool-aged children. This age-related effect is more prominent in boys than in girls.

Hydrocele of the canal of Nuck: value of radiological diagnosis

Hydrocele of the canal of Nuck (cyst of the canal of Nuck) is the female homologue of hydrocele of the spermatic cord in males and is a rarely encountered entity, mostly diagnosed on the operating table at the time of suspected inguinal hernia surgery, as the clinical presentation usually is subtle and inconclusive. Diagnosis is mainly by ultrasound and has shown varied presentation of the same over the years. We discuss the sonographic findings of a case of hydrocele of the canal of Nuck.

Correlation between ventriculoperitoneal shunts and inguinal hernias in children: an 8-year follow-up

OBJECTIVE

The goal of this study was to investigate the correlation between ventriculoperitoneal shunts (VPSs) and inguinal hernias (IHs) in children.

METHODS

Study subjects were identified from a nationwide cohort of 1 537 843 children aged 0 to 5 years from 1996 to 2000. They were assigned to the VPS group (n=675), who received VPS, or a control group (n=6704) of age- and gender-matched children. Both groups (N=7379) were followed up for 8 years for IH. Kaplan-Meier and Cox regression analyses were performed.

RESULTS

After the 8-year follow-up, 353 of the 7379 study subjects (78 from the VPS group and 275 from the control group) underwent IH surgery. The 8-year cumulative incidence rate of IH-repair surgery was 13.3% in the VPS group, significantly higher than that in the control group (4.1%; P<.001). Children in the VPS group were more likely to develop IH than the control group (hazard ratio: 3.62; P<.001), even after adjusting for age, gender, and comorbidities (adjusted hazard ratio: 6.63; P<.001). The average time interval between VPS and IH surgery was 1.73 years earlier in the VPS group than those in the control group (1.29 vs 3.02 years; P<.001).

CONCLUSIONS

Children who received a VPS when younger than 5 years were more likely to have IH; the highest risk was during the first 2 years after VPS surgery. A high index of suspicion for inguinal manifestations is recommended during their follow-up.

Sonographic appearance of canal of Nuck hydrocele

We present a case of a relatively uncommon entity in a 17-year-old girl who presented to the emergency department with right inguinal pain and discomfort. On sonography, she was thought to have a hydrocele of a patent processus vaginalis, although differentials could not be excluded. The hydrocele was subsequently confirmed at surgery. Because this is an uncommonly reported condition, a high index of suspicion must be maintained in the appropriate clinical setting. We present various sonographic appearances and techniques that have been proposed in the literature.