Logo

Tip of Peritoneal Catheter of Ventriculo- Peritoneal Shunt in Scrotum

Author(s):
Seyed Amir JavadiSeyed Amir JavadiSeyed Amir Javadi ORCID1,*, Fereshteh NaderiFereshteh Naderi2
1Neurosurgery Department, Tehran University of Medical Sciences, Tehran, Iran
2Neurology Department, Alborz University of Medical Sciences, Karaj, Iran

Archives of Neuroscience:Vol. 4, issue 3; e58389
Published online:Jul 30, 2017
Article type:Letter
Received:Jul 21, 2017
Accepted:Jul 24, 2017
How to Cite:Javadi S A, Naderi F, Tip of Peritoneal Catheter of Ventriculo- Peritoneal Shunt in Scrotum.Arch Neurosci.2017;4(3):e58389.https://doi.org/10.5812/archneurosci.58389.

Dear Editor,

A ten-month male infant referred at emergency room with enlargement and fluid accumulation in right scrotum without any history of epididymitis or orchitis. Patient had a history of V-P shunt surgery two months earlier. At physical examination, no sign of hydrocephalus or fever was detected. However, a hard substance could be palpated at scrotum. Ultrasonography detected CSF hydrocele with echogenic tip of peritoneal catheter in right scrotum passing through inguinal canal without any sign of intestinal hernia. Radiologic assessment indicated radio-opaque catheter at pelvic area (Figure 1). CSF analysis detected no bacteria and the CSF profile, CBC and urine analyses were normal. The patient underwent direct repair of patent processus vaginalis and repositioning of catheter into peritoneum. Hydrocele improved at early postoperative period and the 6 months follow up outcome was excellent.

X-ray of peritoneal catheter displacement into scrotum through inguinal canal; red pointer indicates opaque peritoneal catheter.
Figure 1.

X-ray of peritoneal catheter displacement into scrotum through inguinal canal; red pointer indicates opaque peritoneal catheter.

A total of 30 cases of peritoneal shunt displacement into scrotum are reported in literature (1); their pattern follows the time course of patent processus vaginalis (PPV) which remains patent up to 60% of neonates during the first year of life (1, 2). The residual peritoneal cavity correlates with body surface, therefore younger pediatric patients have a higher tendency to have V-P shunt distal catheter migrate into the scrotum due to patent processus vaginalis and smaller peritoneal cavity (3).

The most suggested and acceptable treatment for such pediatric cases is direct repair of PPV and ligation of the sac, since increased CSF pressure prevents spontaneous occlusion of PPV (2-5). Some even suggest assessment and prophylactic repair of the other side, when applicable. Early and accurate intervention could prevent further complications and make significant improvements. Laparoscopic approach has been shown to be associated with a lower rate of malposition, distal obstruction and distal shunt failure (2, 6, 7).

References

  • 1.
    Mohammadi A, Hedayatiasl A, Ghasemi-Rad M. Scrotal migration of a ventriculoperitoneal shunt: a case report and review of literature. Med Ultrason. 2012;14(2):158-60. [PubMed ID: 22675718].
  • 2.
    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;29:219-22. [PubMed ID: 27883967]. https://doi.org/10.1016/j.ijscr.2016.11.002.
  • 3.
    Oktem IS, Akdemir H, Koc K, Menku A, Tucer B, Selcuklu A, et al. Migration of abdominal catheter of ventriculoperitoneal shunt into the scrotum. Acta Neurochir (Wien). 1998;140(2):167-70. [PubMed ID: 10398996].
  • 4.
    Ozveren MF. Migration of the abdominal catheter of a ventriculoperitoneal shunt into the scrotum. Neurol Med Chir. 1999;39(4):313-5.
  • 5.
    Hung SW. A 5-month-old infant with right scrotum swelling; a case report. Emerg. 2017;5(1):14.
  • 6.
    Phan S, Liao J, Jia F, Maharaj M, Reddy R, Mobbs RJ, et al. Laparotomy vs minimally invasive laparoscopic ventriculoperitoneal shunt placement for hydrocephalus: A systematic review and meta-analysis. Clin Neurol Neurosurg. 2016;140:26-32. [PubMed ID: 26615465]. https://doi.org/10.1016/j.clineuro.2015.10.025.
  • 7.
    Svoboda SM, Park H, Naff N, Dorai Z, Williams MA, Youssef Y. Preventing Distal Catheter Obstruction in Laparoscopic Ventriculoperitoneal Shunt Placement in Adults: The "Falciform Technique". J Laparoendosc Adv Surg Tech A. 2015;25(8):642-5. [PubMed ID: 26186206]. https://doi.org/10.1089/lap.2015.0196.
comments

Leave a comment here


Crossmark
Crossmark
Checking
Share on
Cited by
Metrics

Purchasing Reprints

  • Copyright Clearance Center (CCC) handles bulk orders for article reprints for Brieflands. To place an order for reprints, please click here (   https://www.copyright.com/landing/reprintsinquiryform/ ). Clicking this link will bring you to a CCC request form where you can provide the details of your order. Once complete, please click the ‘Submit Request’ button and CCC’s Reprints Services team will generate a quote for your review.
Search Relations

Author(s):

Related Articles