African Journal of Paediatric Surgery About APSON | PAPSA  
Home About us Editorial Board Current issue Search Archives Ahead Of Print Subscribe Instructions Submission Contact Login 
Users Online: 743Print this page  Email this page Bookmark this page Small font size Default font size Increase font size 

CASE REPORT Table of Contents   
Year : 2009  |  Volume : 6  |  Issue : 2  |  Page : 116-117
Patent processus vaginalis: A window to the abdomen

Department of Paediatric Surgery, Children's Hospital Oxford, University of Oxford, United Kingdom

Click here for correspondence address and email

Date of Web Publication29-Jul-2009


A patent processus vaginalis (PPV) allows a communication between the peritoneum and scrotum. Hydrocoele is the usual presentation of a PPV in children. However, with intraabdominal pathology the patent PPV may provide the first clue to the mischief within the abdomen. We present here two unusual cases associated with a PPV and migration of intraabdominal contents from the abdomen to the scrotum.

Keywords: Appendicitis, patent processus vaginalis, ventriculoperitoneal shunt

How to cite this article:
Rahman N, Lakhoo K. Patent processus vaginalis: A window to the abdomen. Afr J Paediatr Surg 2009;6:116-7

How to cite this URL:
Rahman N, Lakhoo K. Patent processus vaginalis: A window to the abdomen. Afr J Paediatr Surg [serial online] 2009 [cited 2023 Feb 7];6:116-7. Available from:

   Introduction Top

A patent processus vaginalis (PPV) has been estimated to be present in 80-95% of all male newborns, declining to 60% at one year of age, 40% at two years, and 15- 37% thereafter. [1] It represents a natural communication between the peritoneum and scrotum through which bowel or peritoneal fluid may descend. We present two unusual cases associated with a PPV and migration of intraperitoneal contents from the abdomen to the scrotum.

   Case Reports Top

Case 1

A four-year-old boy with hydrocephalus secondary to a pilocytic astrocytoma underwent insertion of a ventriculoperitoneal (VP) shunt along with tumour debulking and chemotherapy. One month later, he presented with a right reducible inguinal hernia and an intermittent hydrocele. Both testes were palpable within the scrotum. He underwent elective ligation of his right PPV. During examination under anaesthesia coils of the VP shunt were palpable within the scrotum. This was confirmed by plain abdominal radiography [Figure 1]. Intraoperatively, the VP shunt was found to have migrated via a PPV into the scrotum. The tip of the shunt was excised prior to repositioning it back into the peritoneum and the PPV ligated proximally. He received a course of oral antibiotics.

Case 2

A seven-year-old boy underwent appendicectomy confirming the presence of a perforated appendix with purulent fluid in the abdominal cavity. Cultures were taken and peritoneal irrigation performed. He received perioperative antibiotics which were continued postoperatively. On the fourth postoperative day, he developed an acute left hemiscrotum. He underwent urgent exploration of the hemiscrotum and was found to have pus within the tunica extending proximally into a PPV. This was managed successfully with drainage. Cultures from the scrotal abscess matched the intraabdominal cultures and grew E. coli and Streptococcus milleri . The patient recovered uneventfully.

   Discussion Top

Although present in the majority of newborn male infants, the incidence of a PPV declines to 60% at the age of one year and 15% to 37% at adulthood. It allows the passage of intraperitoneal contents between the abdomen and scrotum, and 20% of those in whom the PPV remains patent will present clinically with an inguinal hernia or hydrocele during their lifetime. [2] This route will also allow the passage of other intraperitoneal fluid including blood, as seen occasionally following splenic rupture, [3] and peritoneal dialysis fluid in renal patients. [4]

Increased intraabdominal pressure may be related to the development of inguinal hernia and there is increased incidence of hernia and hydrocele in children who have had VP shunt placement; [5] who are also more likely to develop contralateral hernia.

In addition to the more frequent complications seen with VP shunts, such as blockage and infection, migration of the catheter has been described into the stomach, gallbladder, bladder, vagina, liver, chest, [6] and even transorally. [7] In our first case, the VP shunt had migrated from the abdomen into the scrotum via a PPV. Although rare, a clinician should consider VP shunt migration in any patient who has a shunt in place and presents with an inguinal mass, scrotal swelling, or an acute scrotum. Management includes administration of an antibiotic with gram-positive coverage capable of penetrating the blood-brain barrier along with reduction of the herniated shunt and closure of the PPV.

Our second case represents a rare complication of perforated appendicitis. Intraperitoneal abscess formation following perforated appendicitis is a common occurring in 8% to 14% of the patients. [8] However, the passage of pus through a PPV into the scrotum is rare. In a patient presenting with an acute scrotum following a suppurative appendicitis, scrotal abscess secondary to a PPV must be considered. Patients known to have an inguinal hernia preoperatively, or those in whom a PPV is found intraoperatively, should be carefully monitored in the postoperative period and explored early if scrotal pain develops. Repair of the hernia at time of appendicectomy is not recommended, as this may lead to isolation of infected fluid in the scrotum. [9] If a scrotal abscess is formed, early diagnosis and surgical intervention is essential to avoid complications including testicular gangrene. [10]

Our two cases highlight that a PPV represents a window to the abdomen and may be the cause for unusual scrotal pathology.

   References Top

1.Watson DS, Sharp KW, Vasquez JM, Richards WO. Incidence of inguinal hernia diagnosed during laparoscopy. South Med J 1994;87:23-5.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Rowe MI, Copelson LW, Clatworthy HW. The patent processus vaginalis and the inguinal hernia. J Pediatr Surgery1969;4:102-7.  Back to cited text no. 2    
3.Skoog SJ, Belman AB. The communicating hydrocele: An usual presentation for blunt splenic trauma. J Urol 1986;136:1092-3.  Back to cited text no. 3  [PUBMED]  
4.Abraham G, Blake PG, Mathews RE. Genital swelling as a surgical complication of continuous ambulatory peritoneal dialysis. Surg Gynecol Obstet 1990;170:306-8.  Back to cited text no. 4    
5.Grosfeld JL, Cooney DR. Inguinal hernia after ventriculoperitoneal shunt for hydrocephalus J Pediatr Surg 1974;9:311-5.  Back to cited text no. 5    
6.Borkar SA, Satyarthee GD, Khan RN, Sharma BS, Mahaptra AK. Spontaneous extrusion of migrated ventriculoperitoneal shunt catheter through chest wall: A case report. Turkish Neurosurgery 2008;18:95-8.  Back to cited text no. 6    
7.Berhouma M, Messerer M, Houissa S, Khaldi M. Transoral protrusion of a peritoneal catheter: A rare complication of ventriculoperitoneal shunt. Pediatr Neurosurg 2008;44:169-71.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Schmit PJ, Hiyama DT, Swisher SG, Bennion RS, Thompson JE. Analysis of risk factors of postappendectomy intraabdominal abscess. J Am Coll Surg 1994;179:721-6.  Back to cited text no. 8    
9.Thakur A, Buchmiller T, Hiyama D, Shaw A, Atkinson J. Scrotal abscess following appendendectomy. Pediatr Surg Int 2001;17:569-71.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Robertson FM, Olsen SB, Jackson MR, Rochon RB. Inguinal-scrotal suppuration following treatment of perforated appendicitis. J Pediatr Surg 1993;28:267-8.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]

Correspondence Address:
K Lakhoo
Children's Hospital Oxford, Headley Way, Oxford OX3 9DU
United Kingdom
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0189-6725.54778

Rights and Permissions


  [Figure 1]

This article has been cited by
1 Treatment Options for Scrotal Migration of Ventriculoperitoneal Shunts: Case Illustration and Systematic Review of 48 Cases
Thomas Hauser, Christian Auer, Johanna Ludwiczek, Wolfgang Senker, Philip-Rudolf Rauch, Simon Kargl, Andreas Gruber
Operative Neurosurgery. 2021; 21(3): 87
[Pubmed] | [DOI]
2 Intraperitoneal abscess from perforated diverticulitis with fistualization to extraperitoneal abscess into the scrotum: a case report
Julia T. Scali, Young G. Son, Ian T. Madison, Benjamin A. Fink, Thomas J. Mueller
African Journal of Urology. 2021; 27(1)
[Pubmed] | [DOI]
3 Inguinal Extrusion of a Ventriculoperitoneal Shunt
Jacob Mazza, Michael G. Brandel, Jeffrey A. Steinberg, Hoi Sang U
World Neurosurgery. 2020; 138: 242
[Pubmed] | [DOI]
4 Persistence of the processus vaginalis and its related disorders
Michelle Brainwood, Geraldene Beirne, Michelle Fenech
Australasian Journal of Ultrasound in Medicine. 2020; 23(1): 22
[Pubmed] | [DOI]
5 Utility of Scintigraphy in Assessment of Noninfectious Complications of Peritoneal Dialysis
Gagandeep Choudhary, Padma P. Manapragada, Eric Wallace, Pradeep Bhambhvani
Journal of Nuclear Medicine Technology. 2019; 47(2): 163
[Pubmed] | [DOI]
6 Scrotal Pain and Ulceration Post HIPEC: A Case Report
Nazirul Hannan B. Abdul Aziz,Weining Wang,Melissa Ching Ching Teo
Journal of Gastrointestinal Cancer. 2014;
[Pubmed] | [DOI]
7 Rare complication of ventriculoperitoneal shunt. Early onset of distal catheter migration into scrotum in an adult male: Case report and literature review
Bryan S. Lee,Sumeet Vadera,Jorge A. Gonzalez-Martinez
International Journal of Surgery Case Reports. 2014;
[Pubmed] | [DOI]
8 result 1 Document Scrotal migration of a ventriculoperitoneal shunt: A case report and review of literature
Mohammadi, A., Hedayatiasl, A., Ghasemi-rad, M.
Medical Ultrasonography. 2012;
9 Unusual cause of a painful right testicle in a 16-year-old man: A case report
Shehzad, K.N., Riaz, A.A.
Journal of Medical Case Reports. 2011; 5(art 27)
10 Scrotal Migration of the Peritoneal Catheter of a Ventriculoperitoneal Shunt in a 5-Year-Old Male
Daisuke KITA, Yasuhiko HAYASHI, Masashi KINOSHITA, Kazunori OHAMA, Jun-ichiro HAMADA
Neurologia medico-chirurgica. 2010; 50(12): 1122
[VIEW] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  

    Case Reports
    Article Figures

 Article Access Statistics
    PDF Downloaded522    
    Comments [Add]    
    Cited by others 10    

Recommend this journal