title: Case report of migration of 2 ventriculoperitoneal shunt catheters to the scrotum: Use of an inguinal incision for retrieval, diagnostic laparoscopy and hernia repair.
abstract: BACKGROUND
  Ventriculoperitoneal shunts are commonly used in the treatment of hydrocephalus, and catheter migration to various body sites has been reported. Pediatric and general surgeons are asked on occasion to assist with intraabdominal access for these shunts, particularly when there may be extensive adhesions or other complicating factors.
  
  
  METHODS
  We describe a case in which an old shunt catheter was never removed from the abdomen, and it migrated through an inguinal hernia into the scrotum. The catheter became entangled and fibrosed to the testicle. A second and more recent shunt catheter was also in the scrotum. A single incision in the inguinal region was used to remove both shunt catheters, repair the inguinal hernia and perform diagnostic laparoscopy to assist in placing a new ventriculoperitoneal shunt.
  
  
  RESULTS
  Prompt surgical removal is recommended for catheters remaining in the abdomen after ventriculoperitoneal shunt malfunction. These catheters may cause injury to the testicle, or possibly other intraabdominal organs. General or pediatric surgical consultation should be obtained for lost catheters or inguinal hernias.
  
  
  CONCLUSIONS
  In the case of an inguinal hernia containing a fractured shunt catheter, the hernia sac can be used to remove the catheter, repair the hernia and gain laparoscopic access to the abdomen to assist with shunt placement.
authors.affiliation: Department of Surgery, Paul L Foster School of Medicine, Texas Tech University, EI Paso, TX, USA.
authors.forename: Caesar
authors.initials: C
authors.lastname: Ricci
authors.affiliation: Neurosurgical Specialists of El Paso, El Paso, TX, USA.
authors.forename: Bratislav M
authors.initials: BM
authors.lastname: Velimirovic
authors.affiliation: Department of Surgery, Paul L Foster School of Medicine, Texas Tech University, EI Paso, TX, USA. Electronic address: tnfitz@hotmail.com.
authors.forename: Tamara N
authors.initials: TN
authors.lastname: Fitzgerald
keywords: Case report; Laparoscopic-Assisted ventriculoperitoneal shunt placement; Post-operative shunt complication; Scrotal migration; Ventriculoperitoneal shunt