title: Rare complication of ventriculoperitoneal shunt. Early onset of distal catheter migration into scrotum in an adult male: Case report and literature review.
abstract: BACKGROUND
  The role of shunt placement is to divert cerebrospinal fluid from within the ventricles to an alternative location in the setting of hydrocephalus. One of the rare shunt complications is distal catheter migration, and various body sites have been reported, including the scrotum. Although cases of scrotal migration of distal catheter have been reported in pediatric patients, cases in adult patients are rare due to obliterated processus vaginalis. Furthermore, there has not been a case reported for scrotal migration in an adult at an early onset.
  
  
  METHODS
  65-year-old male underwent shunt placement for normal-pressure hydrocephalus-like symptoms. On post-operative day seven patient developed right testicular edema, for which ultrasound was performed, revealing hydrocele along with the presence of distal catheter in the scrotum. On post-operative day nine patient underwent distal catheter trimming via laparoscopic approach with general surgery, with post-operative imaging showing satisfactory location of distal catheter in the peritoneal cavity.
  
  
  CONCLUSIONS
  Early onset of distal catheter migration into scrotum in an adult male is a unique case, as most cases are reported in pediatric patients, and it is the first case reported in the English literature to have occurrence at an early onset during the peri-operative period. As our case demonstrates, early occurrence and detection of scrotal migration of the distal catheter prevent shunt malfunction. Prompt surgical management of catheter repositioning is therefore recommended to avoid the risk of further complications.
authors.affiliation: Cleveland Clinic Foundation, Department of Neurological Surgery, United States.
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Lee
authors.affiliation: Assistant professor of neurosurgery, University of California, Irvine, 101 The City Drive, Bldg 200, Suite 210 Orange, CA 92868, United States.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Vadera
authors.affiliation: Cleveland Clinic Foundation, Department of Neurological Surgery, United States. Electronic address: gonzalj1@ccf.org.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Gonzalez-Martinez
keywords: Hydrocele; Post-operative shunt complications; Scrotal migration; Ventriculoperitoneal shunt