INGUINAL HERNIATION WITH GLIAL IMPLANTS - POSSIBLE COMPLICATION OF VENTRICULOPERITONEAL SHUNTING

The standard treatment of hydrocephalus is the insertion of a valve-re gulated ventriculoperitoneal (VP) shunt, which may result in the devel opment or clinical worsening of an inguinal hernia or hydrocele. A rev iew of the British Columbia's Children's Hospital experience with VP s hunt insertion (1983-1994) identified 304 patients who underwent VP sh unt placement, 31 of whom subsequently required herniorrhaphy, 5 suffe ring recurrences. Two cases exhibited areas of glial differentiation ( diffusely scattered in one sac from a bilateral repair, focally presen t in the second unilateral hernia repair) displaying cytoplasmic stain ing with glial fibrillary acidic protein and S100. At time of surgical repair of case 1 (bilateral hernia repair), the tip of the VP shunt w as detected within the hernia sac exhibiting glial differentiation; no glial tissue was identified in the sac fr om the other side. We concl ude that inguinal herniation is a common complication of vp shunt inse rtion, and the identification of glial tissue within such an inguinal hernia is a rarer complication, possibly occurring when the shunt tip lies in close proximity to the hernial mesothelial tissue.