Inguinal herniation with glial implants: possible complication of ventriculoperitoneal shunting.
The standard treatment of hydrocephalus is the insertion of a valve-regulated ventriculoperitoneal (VP) shunt, which may result in the development or clinical worsening of an inguinal hernia or hydrocele. A review of the British Columbia's Children's Hospital experience with VP shunt insertion (1983-1994) identified 304 patients who underwent VP shunt placement, 31 of whom subsequently required herniorrhaphy, 5 suffering recurrences. Two cases exhibited areas of glial differentiation (diffusely scattered in one sac from a bilateral repair, focally present in the second unilateral hernia repair) displaying cytoplasmic staining with glial fibrillary acidic protein and S100. At time of surgical repair of case 1 (bilateral hernia repair), the tip of the VP shunt was detected within the hernia sac exhibiting glial differentiation; no glial tissue was identified in the sac from the other side. We conclude that inguinal herniation is a common complication of VP shunt insertion, and the identification of glial tissue within such an inguinal hernia is a rarer complication, possibly occurring when the shunt tip lies in close proximity to the hernial mesothelial tissue.
Magee
J F
JF
Department of Anatomic Pathology, University of British Columbia Vancouver, British Columbia's Children's Hospital, Vancouver, Canada.
Barker
N E
NE
Blair
G K
GK
Steinbok
P
P
D005260:Female; D006552:Hernia, Inguinal / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009457:Neuroglia / Q000473:pathology*; D019736:Prostheses and Implants / Q000009:adverse effects*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*