Scrotal Migration of The Distal End of The Ventriculoperitoneal Shunt: Is There a Role for Early Closure of Patent Processus Vaginalis in The Pediatric Population?

Background: Ventriculoperitoneal shunt (VP) insertion is one of the surgical treatments for patients with hydrocephalus. Infection, malfunction, catheter migration, hernia development, equipment failure, CSF subcutaneous collection and peritoneal pseudocyst formation are considered to be the main complications of this procedure. Case Description: A 6-months-old boy known to have congenital aqueductal stenosis with VP shunt insertion at the age of 1 month, presented with scrotal swelling and generalized hypotonia. He was found to have catheter migration into the scrotum. Conclusion: Scrotal migration of the distal end of the ventriculoperitoneal shunt is a rare but threatening complication that can present with either signs of hydrocephalus or scrotal swelling or hydrocele. Accordingly, we recommend performing a scrotal exam with an ultrasound early upon evaluation of any infant presenting with scrotal swelling or hydrocele after VP shunt insertion. There haven’t been clear recommendations in the literature concerning closure of patent processus vaginalis upon placing a VP shunt in patients below the age of 3 months. Thus, we question whether early closure could help reduce the complications of catheter migration in infants.