Scrotal migration of the peritoneal catheter of a ventriculoperitoneal shunt: A case series in a single center.

Background: Distal migration of ventriculoperitoneal (VP) shunt catheters to the scrotum is a rare yet significant complication in pediatric neurosurgery. It presents a unique challenge due to the anatomical predisposition observed in children.

Case description: This case series elucidates three pediatric cases in which distal VP shunt migration to the scrotum manifested with varied presentations, including scrotal swelling, vomiting, and seizures. Each patient's medical history included prior VP shunt insertion for the management of hydrocephalus, with migration occurring within months of placement. Imaging studies confirmed scrotal positioning of the distal catheter tips, necessitating distinct management strategies: shunt repositioning, conversion to a ventriculoatrial (VA) shunt, and high ligation of a patent processus vaginalis (PPV) in cases associated with scrotal herniation. Factors such as rapid pediatric growth, high activity levels, and anatomical features, including a PPV, may facilitate catheter migration from the abdomen to the scrotum. These cases reflect diverse management approaches tailored to individual presentations and anatomical considerations, with repositioning and catheter shortening serving as viable strategies for recent, less severe cases, while VA shunt conversion and processus vaginalis ligation address more complex scenarios.

Conclusion: Recognizing scrotal VP shunt migration as a potential complication is essential for early diagnosis and effective intervention. Timely and individualized management strategies are critical to preventing recurrence and ensuring optimal outcomes in the pediatric treatment of hydrocephalus with VP shunts.