Dose Hydrocele in Children Caused by Ventriculoperitoneal Shunt Migration Always Need Surgical Intervention? Watch and Wait - A Rare Cause of Hydrocele

Abstract

Introduction: Ventriculoperitoneal (V-P) shunt is a common surgery for pediatric patients with hydrocephalus. Migration of the shunt to the scrotum is rare. Its clinical presentation may be silent if the shunt keeps patent. We describe such a case following the implantation of a V-P shunt with scrotal migration, with the tip still kept in the peritoneal cavity with patent function. We will discuss this rare complication and review the literature. Case Presentation: A 28-week-old boy presented preterm-related spontaneous intraventricular hemorrhage and hydrocephalus. The patient underwent surgery via V-P shunt implantation. One month after the operation, V-P shunt migration with the right hydrocele was diagnosed while the tip was still in the peritoneal cavity with a patent function. We adopted a watch-and-wait approach in which outpatient follow-up would be continued until the patient was 1.5 years old, when we would decide whether to perform hydrocele repair and correct the drainage tube malposition or continue follow-up. The patient was alert with good activity and close follow-up. Conclusions: Ventriculoperitoneal shunt migration with hydrocele in young children is a rare complication after the surgery. Regular follow-up up to 1.5 years old is recommended for patients with the tip in the peritoneal cavity and patent shunt function. Surgical intervention is suggested for cases with tip in the scrotum, shunt kinking, remarkable hydrocele, or hydrocephalus progression. Although V-P shunt migration is uncommon, we should take care of it to find out and solve the problem.