# Scrotal Migration of the Ventriculoperitoneal Shunt in a 1-Year-Old Pediatric Patient: A Case Report and Systematic Literature Review

## TL;DR

A 1-year-old child's ventriculoperitoneal shunt migrated to the scrotum, and laparoscopic surgery successfully treated it.

## Contribution

This case report and systematic review provide insights into the treatment of rare scrotal migration of VPS in pediatric patients.

## Key findings

- Laparoscopic repositioning of the VPS catheter and closure of the processus vaginalis was effective in 90.4% of cases.
- Scrotal/inguinoscrotal swelling was the most common symptom among 52 pediatric patients analyzed.
- The median age at presentation for scrotal VPS migration was 24 months.

## Abstract

Background: Migration of the peritoneal end of the ventriculoperitoneal shunt (VPS) into the scrotum is a rare but recognized complication. Inguinoscrotal migration typically occurs as a result of increased intra-abdominal pressure combined with a patent processus vaginalis. A 14-month-old pediatric patient presented to the emergency department with abdominal pain, vomiting, and swelling of the right scrotum that had persisted for two days. The patient had a history of a head injury that had resulted in a large secondary arachnoid cyst for which a VPS had been placed at eight months of age. Examination of the inguinoscrotal region revealed a swollen and painful right side of the scrotum with a hydrocele and a palpable distal portion of the ventriculoperitoneal catheter in the right groin extending to the scrotum. After a brief preoperative preparation, the patient underwent laparoscopic abdominal emergency exploration, during which shunt repositioning and laparoscopic closure of the patent processus vaginalis were performed. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 30 case reports and six case series were included, analyzing 52 pediatric patients with scrotal migration of the VPS. The median age at presentation was 24 months (range: 1–169 months). The indication for VPS placement was hydrocephalus. Migration of the VPS catheter occurred on the right side in 34 cases. The median interval from VPS placement to the onset of symptoms was 9.0 months (range: 1 day–72 months). The most frequently reported symptoms were scrotal/inguinoscrotal swelling (n = 50), vomiting (n = 7), and fever (n = 3). Diagnostic methods included abdominal X-ray (n = 43), ultrasound (n = 5), scrotal transillumination test (n = 5), and computed tomography (n = 1). Regarding treatment, surgical repositioning of the VPS catheter into the peritoneal cavity was performed in 47 patients (90.4%), with no intraoperative or postoperative complications reported. Conclusions: Laparoscopic repositioning of the VPS into the peritoneal cavity, combined with closure of the processus vaginalis, appears to be a safe and effective treatment option for scrotal migration of the VPS. However, further well-designed studies are warranted to provide more comprehensive, generalizable, and unbiased evidence regarding this complication in the pediatric population.