Purpose or Case Report: In the treatment of infant hydrocephalus, ventriculoperitoneal (VP) shunts are considered the standard of care. Various complications are associated with VP shunting. Ventriculoperitoneal shunt catheter migration remains a rare but documented complication seen in one in 1000 patients who receive a VP shunt. Migration of the VP shunt into the scrotum is even more uncommon and requires surgical treatment.

We report a unique case of a 6-month-old preterm male with history of hydrocephalus treated with surgically placed VP shunt. He presented with vomiting and was found to have a right inguinoscrotal sac swelling with the tip of the catheter appreciated upon palpation of the sac and later confirmed by abdominal radiograph. After admission, the patient started to show rapid and significant improvement without significant intervention. On further imaging, the positioning of the VP shunt improved with a sufficiently reduced tip highlighting the spontaneous reduction of the distal catheter tip. Repeated imaging months later showed no recurrence.

Scrotal migrations are more common in children, and this is commonly thought to be due to an unobliterated processus vaginalis allowing the catheter tip to enter the scrotal sac. As most patients remain asymptomatic and present only after an exacerbation with co-infections, the importance of early diagnosis should not be neglected. This is crucial to avoid subsequent complications such as acute hydrocephalus, testicular torsion, and peritoneal perforation. For nearly all scrotal VP shunt migration cases, definitive treatment is surgical with manual repositioning followed by hernia repair. VP shunt migration should remain an essential differential of scrotal masses in that patient population. We also want to raise awareness to radiologists about the malposition of the VP shunt catheter and the rare ability for it to reduce and retract into appropriate positioning spontaneously. We believe that these recommendations will help improve quality of care management in pediatric hydrocephalus patients.
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