Indian Journal of Surgery Medknow Publications on behalf of Association of Surgeons of India ISSN: 0972-2068 Vol. 65, Num. 2, 2003, pp. 186-187

Indian Journal of Surgery, Vol. 65, No. 2, March-April, 2003, pp. 186-187

Case Report

Migrated ventriculo-peritoenal shunt in the inguinal hernial sac

Rahul Gupta

Address for correspondence: Dr Rahul Gupta, B-1036, Model House, Jalandhar, Punjab - 144 003.

Paper Received: June 2001, Paper Accepted: January 2002. Source of Support: Nil

Code Number: is03034

ABSTRACT

We present a patient in whom the peritoneal end of the ventriculoperitoneal shunt migrated spontaneously into the inguinal hernial sac and was successfully retrieved. The surgical literature is briefly reviewed.

KEYWORDS: Ventriculoperitoneal shunt, migration

How to cite this article: Gupta R. Migration of a ventriculoperitoenal shunt in the inguinal hernial suc. Indian J Surg 2003;65:186-7.

INTRODUCTION

Ventriculoperitoneal (VP) shunting used in the treatment of hydrocephalus is associated with several complications. These are reported in as many as in 24 per cent to 47 per cent cases.^1,2 We report a rare complication of the migration of the peritoneal end of the shunt into an inguinal hernial sac.

CASE REPORT

A 10-month-old male child weighing 9.5 kg was brought in with a hard cord-like structure in the right side of the scrotum. Following onset of convulsions on the second day of life, he was diagnosed to have a hydrocephalus and had undergone insertion of a medium pressure VP shunt under general anaesthesia. The postoperative recovery was uneventful and he was discharged with oral anticonvulsant therapy.

During the present admission, a provisional diagnosis of irreducible inguinal hernia with a migrated VP shunt was made. Preoperative investigations were normal. The patient was operated upon under general anaesthesia. The right inguinal canal was explored through a groin incision. The spermatic cord and hernial sac were identified and dissected out. A congenital hernial sac was identified which contained the peritoneal limb of the VP shunt. This was folded like a loop and had passed through the internal and external inguinal rings. The shunt was found to be working adequately as evidenced by a pulsatile flow of cerebrospinal fluid (CSF). The limb of the shunt was pushed back into the abdomen. A herniotomy was performed by transfixing and ligating the neck of the sac. The inguinal canal and wound were closed in layers. The postoperative recovery was uneventful and the patient was discharged the day after surgery. He remained well 2 months after surgery.

DISCUSSION

The reported complications related to the VP shunt include its migration and extrusion through the anus² mouth³ vagina,⁴ umbilicus⁵ and urethra.⁶ Factors postulated to be responsible for the propulsion of the peritoneal end of the VP shunt include a) peristaltic gut movements, b) continuous water hammer effect of the pulsations of the CSF, and c) intermittent rise in the intra-abdominal pressure. Presence of a congenital hernial sac can be an automatically available predisposing factor for the migration of the VP shunt into the scrotum. Also, the stiffness and the length of the catheter, age of the patient and the dependent position of the inguinal canal / scrotum may play a role in the occurrence of this complication. The migrated end of the VP shunt is likely to be extruded if it is insecurely anchored to the pericranium.⁷ Another factor responsible for the occurrence of this complication is extensive subcutaneous dissection at the time of primary surgery.

REFERENCES

1. McLaurin RL. Shunt complications. In: Paediatric neurosurgery: Surgery of developing nervous system. New York: Grune and Stratton; 1982. pp. 243-53.
2. Fernandes MA. Extrusion of a ventriculoperitoneal shunt through anus. Indian Paediatr J 1989:26:86-7.
3. Griffith JA, DeFeo D. Peroral extrusion of a ventriculoperitoneal shunt catheter. Neurosurgery 1987;21:259-61.
4. Mozingo JR, Cauthen JC. Vaginal perforation by a Raimondi peritoneal catheter in adult. Surg Neurol 1974,2:195-6.
5. Adeloye A. Spontaneous extrusion of the abdominal tube through the umbilicus complicating peritoneal shunt for hydrocephalus J Neurosurg 1973;38:758-60.
6. Prasad VS, Krishna AM, Gupta PK. Extrusion of peritoneal catheter of ventriculoperitoneal shunt through the urethra. Br J Neurosurg 1995;9:209-10.
7. Sooh M, Mycis HT, Murtagh F, et al. Observations on ventricular and lumbar subarachnoid peritoneal shunts in hydrocephalus in infants. J Neurosurg 1955;12:165-75.

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