1
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Wu Y, Chen Y, Ng LP, Low SYY. Spontaneous regression of migrated ventriculoperitoneal shunt catheter from scrotum to peritoneum: a case-based review. Childs Nerv Syst 2024; 40:19-25. [PMID: 37857859 DOI: 10.1007/s00381-023-06192-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
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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Affiliation(s)
- Yilong Wu
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Yong Chen
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Lee Ping Ng
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- SingHealth Duke-NUS Paediatrics Academic Clinical Program, 100 Bukit Timah Road, Singapore, 229899, Singapore.
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2
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Chanchlani R, Sharma PK, Gunasekaran V, Kasundra A. Scrotal migration of peritoneal end of ventriculoperitoneal shunt in an infant - A rare entity. J Neurosci Rural Pract 2023; 14:365-367. [PMID: 37181190 PMCID: PMC10174175 DOI: 10.25259/jnrp_76_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/18/2023] [Indexed: 03/30/2023] Open
Abstract
Ventriculoperitoneal shunt migration into the scrotum is a rare phenomenon that has been reported in nearly 35 patients in the literature till date. Genitalia-related complications of ventriculoperitoneal shunts in children like inguinoscrotal migration usually occur during 1st year of the shunt procedure due to factors like raised abdominal pressure and patency of process vaginalis. We report a case of scrotal migration of tip of ventriculoperitoneal shunt in a 2-month-old infant presenting to us with communicating hydrocephalus. In a patient with inguinoscrotal swelling and ventriculoperitoneal shunt, migration of shunt should be suspected. Prompt diagnosis and management of this condition is important due to various complications like shunt dysfunction and testicular lesions. Treatment of this condition is surgical closure of the patent processes vaginalis and shunt reposition.
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Affiliation(s)
- Roshan Chanchlani
- Department of Pediatric Surgery, AIIMS, Bhopal, Madhya Pradesh, India
| | | | | | - Ankit Kasundra
- Department of Pediatric Surgery, AIIMS, Bhopal, Madhya Pradesh, India
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3
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Taha MM, Almenshawy HA, Ezzat M, Elbadawy MK. Migration of Distal End of VP Shunt into the Scrotum: A Management Review. Surg J (N Y) 2022; 8:e245-e248. [PMID: 36062184 PMCID: PMC9439880 DOI: 10.1055/s-0042-1756181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022] Open
Abstract
Ventriculo-peritoneal (VP) shunt is the typical and most common procedure for the treatment of hydrocephalus. Many complications have been associated with VP shunts, migration of the distal end of the VP tube into the scrotum is a rare one. We report the presentation and management of a case of 3 month age infant who had scrotal swelling primarily diagnosed as hydrocele. Investigations proved the presence of shunt migration. The possibility of shunt migration should be considered. Early diagnosis and management of such complications is easy and can prevent subsequent serious sequelae.
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Affiliation(s)
- Mahmoud M. Taha
- Department of Neurosurgery, Zagazig University, Zagazig, Egypt
| | | | - Mohammad Ezzat
- Department of Neurosurgery, Zagazig University, Zagazig, Egypt
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4
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Hauser T, Auer C, Ludwiczek J, Senker W, Rauch PR, Kargl S, Gruber A. Treatment Options for Scrotal Migration of Ventriculoperitoneal Shunts: Case Illustration and Systematic Review of 48 Cases. Oper Neurosurg (Hagerstown) 2021; 21:87-93. [PMID: 33989403 DOI: 10.1093/ons/opab152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Scrotal migration of intact or disconnected tubing is a rare complication of ventriculoperitoneal shunts. While some illustrative case reports can be found in the literature, a systematic review on treatment options is lacking. OBJECTIVE To propose the first literature-based treatment algorithm on scrotal shunt migration. METHODS We conducted a literature search using the keywords: "VP," "ventriculoperitoneal," "shunt," and "scrotum." We identified 36 publications with 48 cases reported including our index case. RESULTS Median age at presentation was 13.5 mo (3 d to 65 yr) which was 4 mo (3 d to 72 mo) after last shunt-related surgery. All patients had scrotal swelling, 39 (81%) patients presented without other symptoms, 4 (8%) had additionally local pain, and 4 (8%) patients presented with symptoms of shunt dysfunction. Treatment was surgically in all but one case where spontaneous resolution without repeat migration occurred. In 3 of 4 patients who had either subcutaneous shortening or abdominal repositioning of the shunt without hernia repair, scrotal shunt migration recurred within the following month. Whereas the surgical treatment with reposition of the migrated catheter back into the peritoneal cavity via a groin incision plus hernia repair yielded a definite treatment in all 26 performed cases, the revision rate was significantly higher in the shunt revision without hernia repair cohort (P = .0009). CONCLUSION Scrotal shunt migration is a rare shunt complication with good recovery when treated surgically. We recommend hernia repair in addition to either manual or surgical repositioning of migrated tubing.
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Affiliation(s)
- Thomas Hauser
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
| | - Christian Auer
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
| | - Johanna Ludwiczek
- Department of Pediatric Surgery, Kepler University Hospital, MedCampus 4, Linz, Austria
| | - Wolfgang Senker
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
| | - Philip-Rudolf Rauch
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria
| | - Simon Kargl
- Johannes Kepler University (JKU), Linz, Austria.,Department of Pediatric Surgery, Kepler University Hospital, MedCampus 4, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
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5
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Perret C, Bertani R, Pilon B, Koester SW, Schiavini HC. Acute Hydrocephalus Following a Spontaneous Ventriculoperitoneal Shunt Catheter Fracture With Scrotal Migration. Cureus 2021; 13:e14554. [PMID: 34026372 PMCID: PMC8133507 DOI: 10.7759/cureus.14554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Genitalia-related complications of ventriculoperitoneal shunts, such as scrotal migrations, are rare and most frequently presenting during the first year of the system placement, usually in the pediatric population, due to several factors, including vaginal process patency and increased abdominal pressure. Despite being typically benign, hernias, hydroceles, perforations, and catheter migration to the scrotum can lead to permanent disabilities and lethal complications, such as ventriculoperitoneal shunt dysfunction. We report a case of a late-onset, atraumatic, ventriculoperitoneal shunt fracture and catheter migration to the scrotum in a 22-year-old male, six years after its implantation, presenting in the emergency department due to acute hydrocephalus symptoms.
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Affiliation(s)
- Caio Perret
- Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, BRA
| | - Raphael Bertani
- Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, BRA
| | - Barbara Pilon
- Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, BRA
| | - Stefan W Koester
- Neurosurgery, Vanderbilt University School of Medicine, Nashville, USA
| | - Hugo C Schiavini
- Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, BRA
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6
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Chan AC, Woo PY, Au Y, Chan K, Wong H. Scrotal migration of a ventriculoperitoneal shunt. Surg Pract 2019. [DOI: 10.1111/1744-1633.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Yiu‐Kai Au
- NeurosurgeryKwong Wah Hospital Hong Kong
| | - Kwong‐Yau Chan
- Department of General SurgeryKwong Wah Hospital Hong Kong
| | - Hoi‐Tung Wong
- Department of General SurgeryKwong Wah Hospital Hong Kong
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7
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Soufiany I, Hijrat KA, Soufiany S, Chen L. Mechanisms and Major Sites of Distal Catheter Migration in Ventriculoperitoneal Shunting Maneuvers: A Review Article. Brain Science Advances 2019. [DOI: 10.26599/bsa.2018.9050002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A ventriculoperitoneal shunt (VPS) is a medical device used to deflect cerebrospinal fluid from cerebral ventricles to the peritoneal cavity. Since 1908, ventriculoperitoneal shunts have been considered the best option in hydrocephalus management. Manifestation related to VPS may arise anywhere whilst tunneling the VPS from the ventricle to the peritoneal cavity, but complications associated with the distal catheter are especially common and a leading cause of revision surgeries. Among the many complications associated with peritoneal shunts, migration of the catheter into other parts of the body is still common. Scrotal migration mainly takes place in children aged 4 days to 5 years. Patent processus vaginalis, formation of an inguinal hernia, and increased intraabdominal pressure are leading risk factors associated with migration of the peritoneal catheter into the scrotum. Thoracic migration of peritoneal catheters predominantly occurs in adult patients. Important mechanisms in thoracic migration include (1) iatrogenic perforation of the external or internal jugular veins by the surgeon during tunneling and (2) gradual destruction of the venous structures by the catheter due to routine extension and flexion of the neck. After entering the vessel, negative intrathoracic pressure combined with positive intraabdominal pressure aids migration into the thoracic cavity. Sharp tips or shunt types contribute to intraabdominal migration and perforation.
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Affiliation(s)
- Ismatullah Soufiany
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Khalil Ahmad Hijrat
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Spina Soufiany
- Department of Gynecology/Obstetrics, Mirwais Hospital, School of Medicine, Kandahar University, Kandahar 3802, Afghanistan
| | - Lukui Chen
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
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8
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Deora H, Sharma A, Rao KVLN, Somanna S, V V. Needle in a haystack: migration of ventriculoperitoneal shunt into scrotum of infant. Egypt J Neurosurg 2018. [DOI: 10.1186/s41984-018-0001-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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9
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Shah I, Mullanfiroze K. Scrotal displacement of ventriculoperitoneal shunt. Indian Journal of Medical Specialities 2018. [DOI: 10.1016/j.injms.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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10
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Affiliation(s)
- Farideh Nejat
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
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11
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Hori YS, Nagakita K, Ebisudani Y, Aoi M, Shinno Y, Fukuhara T. Choroid Plexus Hyperplasia with Intractable Ascites and a Resulting Communicating Hydrocele following Shunt Operation for Hydrocephalus. Pediatr Neurosurg 2018; 53:407-412. [PMID: 30157489 DOI: 10.1159/000492333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/22/2018] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Yusuke S Hori
- Department of Neurological Surgery, National Hospital Organization Okayama Medical Center, Okayama,
| | - Keina Nagakita
- Department of Pathology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yuki Ebisudani
- Department of Neurological Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Mizuho Aoi
- Department of Neurological Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yoko Shinno
- Department of Pathology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Toru Fukuhara
- Department of Neurological Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
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12
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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.
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Affiliation(s)
- Monika Bawa
- Department of Pediatric Surgery, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Garge
- Department of Pediatric Surgery, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Garg
- Department of Pediatric Surgery, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Katragadda Lakshmi Narasimha Rao
- Department of Pediatric Surgery, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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Fernandez-Ibieta M, Villamil V, Martinez-Lage J. Migration of a ventriculoperitoneal shunt catheter through the processus vaginalis in infants: how serious inguinal hernia and hydrocele might be. Acta Neurochir (Wien) 2017; 159:1417-1419. [PMID: 28616670 DOI: 10.1007/s00701-017-3243-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 05/31/2017] [Indexed: 11/28/2022]
Abstract
Migration of the catheter tip of a ventriculoperitoneal shunt (VPS) through a patent processus vaginalis (PV) has seldom being reported. In this series, we analyzed all cases of inguinoscrotal migration of an VPS catheter at our center. Between 1975 and 2015, 295 VPS insertions were performed. In seven infants (2.3%), migration of the catheter through a patent PV was demonstrated. Cases with hydroceles had associated VPS malfunction, but cases with hernias were not associated with it. The current recommendation is to delay a PV closure until 2 years of age in cases of infants with hydrocele without further radiological examinations, but this might not be the case in infants with VPS.
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Affiliation(s)
- Maria Fernandez-Ibieta
- Pediatric Surgery Department, Hospital CUV Arrixaca, Crta El palmar s/n, 30012, Murcia, Spain.
| | - Vanesa Villamil
- Pediatric Surgery Department, Hospital CUV Arrixaca, Crta El palmar s/n, 30012, Murcia, Spain
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14
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspective in Pediatric Pathology, Chapter 24. Testicular Inflammatory Processes in Pediatric Patients. Pediatr Dev Pathol 2017; 19:460-470. [PMID: 27575254 DOI: 10.2350/16-08-1828-pb.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acute scrotal pain in children represents a major diagnostic and therapeutic challenge. An important initial differentiation should be made between epididymitis and other processes that cause acute scrotal pain, such as testicular torsion and tumor. Infectious agents disseminating through the blood flow can damage the testis by causing orchitis. On the other hand, infections ascending via spermatic pathways typically lead to epididymitis [ 1 ].
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Affiliation(s)
- Manuel Nistal
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
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15
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Ricci C, Velimirovic BM, Fitzgerald TN. Case report of migration of 2 ventriculoperitoneal shunt catheters to the scrotum: Use of an inguinal incision for retrieval, diagnostic laparoscopy and hernia repair. Int J Surg Case Rep 2016; 29:219-222. [PMID: 27883967 PMCID: PMC5122702 DOI: 10.1016/j.ijscr.2016.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/27/2022] Open
Abstract
A ventriculoperitoneal shunt catheter migrated through an inguinal hernia into the scrotum. A single incision was used to for diagnostic laparoscopy, catheter removal and hernia repair. Prompt surgical removal of fractured shunt catheters is recommended to prevent organ injury.
Backgroud Ventriculoperitoneal shunts are commonly used in the treatment of hydrocephalus, and catheter migration to various body sites has been reported. Pediatric and general surgeons are asked on occasion to assist with intraabdominal access for these shunts, particularly when there may be extensive adhesions or other complicating factors. Methods We describe a case in which an old shunt catheter was never removed from the abdomen, and it migrated through an inguinal hernia into the scrotum. The catheter became entangled and fibrosed to the testicle. A second and more recent shunt catheter was also in the scrotum. A single incision in the inguinal region was used to remove both shunt catheters, repair the inguinal hernia and perform diagnostic laparoscopy to assist in placing a new ventriculoperitoneal shunt. Results Prompt surgical removal is recommended for catheters remaining in the abdomen after ventriculoperitoneal shunt malfunction. These catheters may cause injury to the testicle, or possibly other intraabdominal organs. General or pediatric surgical consultation should be obtained for lost catheters or inguinal hernias. Conclusion In the case of an inguinal hernia containing a fractured shunt catheter, the hernia sac can be used to remove the catheter, repair the hernia and gain laparoscopic access to the abdomen to assist with shunt placement.
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Affiliation(s)
- Caesar Ricci
- Department of Surgery, Paul L Foster School of Medicine, Texas Tech University, EI Paso, TX, USA
| | | | - Tamara N Fitzgerald
- Department of Surgery, Paul L Foster School of Medicine, Texas Tech University, EI Paso, TX, USA.
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16
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Lee BS, Vadera S, Gonzalez-Martinez JA. Rare complication of ventriculoperitoneal shunt. Early onset of distal catheter migration into scrotum in an adult male: Case report and literature review. Int J Surg Case Rep 2014; 6C:198-202. [PMID: 25553524 PMCID: PMC4334951 DOI: 10.1016/j.ijscr.2014.09.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/24/2014] [Indexed: 12/20/2022] Open
Abstract
Cases of scrotal migration of distal catheter in adults are rare. There have been no reports for scrotal migration in adults at an early onset. Early detection of migration of distal catheter prevents shunt malfunction. 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.
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Affiliation(s)
- Bryan S Lee
- Cleveland Clinic Foundation, Department of Neurological Surgery, United States
| | - Sumeet Vadera
- Assistant professor of neurosurgery, University of California, Irvine, 101 The City Drive, Bldg 200, Suite 210 Orange, CA 92868, United States
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18
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Abstract
Shunt surgeries in patients with hydrocephalus are associated with morbidity and mortality. The most common problems are shunt obstruction and malfunction. We described a case of shunt migration into the scrotal sac masquerading as scrotal swelling. Shunt repositioning along with posterior wall repair and herniotomy was performed.
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Affiliation(s)
- Shasanka Shekhar Panda
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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19
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Sharma M, Velho V, Mally R, Hrushikesh K. Vulvar migration of the peritoneal end through the inguinal canal in a female infant: An unusual complication of the ventriculo-peritoneal shunt: A case report and review of literature. J Pediatr Neurosci 2013; 8:67-9. [PMID: 23772251 PMCID: PMC3680903 DOI: 10.4103/1817-1745.111430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Migration of the peritoneal end of the ventriculo-peritoneal shunt through the patent processus vaginalis has been described in preterm male infants with 26 such cases in the literature. The occurrence of this rare complication in the female preterm infants has not yet been reported. We report a 3-month-old premature female infant who presented with a gradual increase in head size since birth. Computed tomography revealed obstructive hydrocephalous secondary to the aqueductal stenosis and ventriculo-peritoneal shunt was performed. Ten days following the procedure she presented with swelling and other signs of inflammation over the right vulvar region. X-ray abdomen confirmed the migration of the peritoneal end into the vulva. Surgical obliteration of the patent processus vaginalis and replacement of the peritoneal end was performed. The patient had no recurrence at 6 months of follow-up. This report presents the unusual complication of a common procedure in a female infant with a review of the current literature.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, Maharashtra, India
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Korfias S, Alexiou GA, Vlachakis E, Sakas DE. Scrotal swelling due to migration of the abdominal catheter of a cyst-peritoneal shunt. Clin Neurol Neurosurg 2013; 115:1918-9. [PMID: 23622934 DOI: 10.1016/j.clineuro.2013.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 02/08/2013] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
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