Migration of ventriculoperitoneal shunt catheter into scrotum: case report and literature review

Introduction: We present a case report in which there was migration of the peritoneal catheter into the scrotum, a rare complication. Nursling, 46 days, with previous history of ventriculoperitoneal shunt in the third day of life, was admitted with scrotal swelling in the emergency. The patient was a pre-term newborn – 35 weeks and 5 days at the birth – with congenital hydrocephalus diagnosed in obstetric ultrasound. In the hospitalization evolved with shunt dysfunction and infection. Propaedeutic have shown distal catheter within the scrotum on the right side. The shunt was withdrawn, and treatment was initiated for device infection. Serial cerebrospinal fluid relief punctures were performed during the clinical treatment. At the end of it, after 14 days of antibiotics, a new shunt was implanted and bilateral hernioplasty were performed.

Discussion: The ventriculoperitoneal shunt is the most used surgical procedure in the treatment of hydrocephalus. It is associated with numerous mechanical complications, between them, the migration of the catheter. The patency of procesus vaginalis is the predisposing anatomical condition for the migration of the shunt catheter into the scrotum and are present in up to 60% of the infants of 1 year old. Prematurity configures a risk factor for patency of the procesus vaginalis. The migration of the catheter occurs more commonly until 12 months after the surgery e usually in the right side.

Final Comments: The presence of scrotal swelling in a patient with ventriculoperitoneal shunt should trigger the investigation of catheter migration. The diagnosis is necessary in account of the complications, such as testicle lesions and shunt dysfunction. Treatment must evolve the repositioning of the distal catheter associated with the closure of the patent procesus vaginalis.