HYDROCELE FOLLOWING PLACEMENT
OF A VENTRICULOPERITONEAL SHUNT
C A S E R E P O R T
JOSÉ SENA CALVÁRIO * — ELISEU PAOLIOLI NETO **
S U M M A R Y — The authors report the case of a t w o years old patient with hydrocele alter ventriculoperitoneal shunt procedure.
Hidrocele após colocação de derivação ventrículo-peritoneal: registro de caso.
R E S U M O — Os autores registram um caso d e hidrocele surgida após colocação de shunt ventrículo-peritoneal em paciente com dois anos de idade.
Numerous abdominal complications have been reported subsequent to ventriculo-peritoneal shunting procedures for the treatment of hydrocephalus!. Intra abdominal complications of peritoneal shunts include: perforation of the gallblader; inguinal hernia, ascites and cyst formation; intestinal volvulus and obstruction, perforation of a viscus, or to the outside; spread of neoplasm or infection to the peritoneal cavity 2,8,9.
Although a variety of complications have been well documented, there has been little attention given in the literature to the association with hydrocele illustrated in the following case.
C A S E R E P O R T
F H , a two year old male patient, had undergone repair for hydrocephalus; a ventriculo-peritoneal shunt w a s placed at thirty days using a Raimondi middle-pressure ventriculo-peritoneal catheter. T h e course w a s uneventful; on routine pediatric evaluation swelling of the scrotum was noted without evidence of inguinal bulge ( F i g . 1). Abdominal roentgenogram revealed the catheter tip in the right scrotum ( F i g . 2 ) , and uncomplicated surgical repair and shunting repositioning followed.
C O M M E N T S
Ventriculoperitoneal shunts are the procedure of choice in the treatment ot hydrocephalus at our institution. W e present an unusual complication of this procedure.
T h e first cerebrospinal fluid ( C S F ) shunt to the peritoneal cavity is credited to Ferguson 3 w h o in 1898 laid a silver w i r e in a fistulous tract from the lumbar sub-arachnoid space at the b o d y of L - 5 . T h i s method and all other early attempts failed, and it w a s not until about 25 years a g o that some success w a s reported 5,6, W h e n the Spitz-Holter valve and suitable catheter material became available, the technique
*Hospital M ã e de Deus, Porto A l e g r e ; ** Instituto de Neurocirurgia, Santa Casa de Misericórdia, Porto Alegre.
of ventriculovenous shunting became popular. It w a s soon learned that serious com-plications with ventriculoatrial shunt w e r e not infrequent and, in 1967, attention was again turned to the peritoneal cavity. T h e history of the evolution of ventricular shunting for hydrocephalus is largely related to efforts in preventing the complications of shunting. Until a time in which pharmacologic control of C S F production will be achieved, the treatment of hydrocerthalus will rely mainly on the establishment of artificial conduits for the venting of C S F from the ventricular system. Such devices have been fraught with mechanical and biological complications.
Hydrocele as a complication of a peritoneal shunt has been cited as an infre-quent finding in one reported earlier series 7. Recently a 26% incidence of clinical inguinal hernia has been noted to occur on the a v e r a g e within seven months after the initial ventriculoperitoneal shunt procedure 4. T h e s e findings suggest that parti-cular attention should be given to subtle signs of inguinal hernia or increasing hydrocele formations both before and specially after peritoneal shunting. In particular, the inguinal and scrotal areas should be regulary observed by all those responsible for evaluating peritoneal shunt functioning.
of ventriculovenous shunting became popular. It w a s soon learned that serious com-plications with ventriculoatrial shunt w e r e not infrequent and, in 1967, attention was again turned to the peritoneal cavity. T h e history of the evolution of ventricular shunting for hydrocephalus is largely related to efforts in preventing the complications of shunting. Until a time in which pharmacologic control of C S F production will be achieved, the treatment of hydrocerjhalus will rely mainly on the establishment of artificial conduits for the venting of C S F from the ventricular system. Such devices have been fraught with mechanical and biological complications.
Hydrocele as a complication of a peritoneal shunt has been cited as an infre-quent finding in one reported earlier series 7. Recently a 26% incidence of clinical inguinal hernia has been noted to occur on the a v e r a g e within seven months after the initial ventriculoperitoneal shunt procedure 4. T h e s e findings suggest that parti-cular attention should be given to subtle signs of inguinal hernia or increasing hydrocele formations both before and specially after peritoneal shunting. In particular, the inguinal and scrotal areas should be regulary observed by all those responsible for evaluating peritoneal shunt functioning.
R E F E R E N C E S
1. Adeloye A — Spontaneous extrusion of the abdominal tube through the umbilicus com-plicating peritoneal shunt for hydrocephalus: case report. J N e u r o s u r g 38:758, 1973. 2. Ames R H — Ventriculo-peritoneal shunts in the management of hydrocephalus. J Neurosurg
27:525, 1967.
3. Ferguson A H — Intraperitoneal diversion of the cerebrospinal fluid in cases of hydroce-phalus (review). N Y M e d J 67:902, 1898.
4. Grosfeld J — Intra abdominal complications following ventriculoperitoneal shunt proce-dures. Pediatrics 54:791, 1974.
