Two children with VP shunt migration presented to us interestingly almost at the same time, one week apart. The first was a 14-month-old boy, who presented with fever, cough and loose stool. He had undergone ventriculo peritoneal (VP) shunt at the age of two months for hydrocephalus following intraventricular hemorrhage . He was a preterm baby with growth retardation and developmental delay, receiving thyroxine and valproate. On examination, he had open anterior fontanel with normal tension and patent VP shunt. He had a reducible right indirect inguinal hernia and hydrocele. On the second day of admission, he developed excessive intermittent crying and increase in size of scrotal swelling. On transillumination, a cord like structure was seen in the scrotum (Fig.1). When the hernia was reduced, his crying stopped, but the cord like structure persisted, which was clinically diagnosed as VP shunt tube. CT head revealed moderate hydrocephalus and VP shunt in situ. USG scrotum showed hydrocele right side with VP shunt tube seen extending to the right scrotal sac. X-ray abdomen showed shunt tube extending from abdomen into the scrotum (Fig. 2). Herniotomy and repositioning of VP shunt tube were done.

Fig. 1 Transillumination of scrotum showing VP shunt tube.	Fig. 2 X- Ray showing migration of VP shunt into the scrotum.

The second was a one-year-old female child, with colpocephaly and partial corpus callosal dysgenesis with hydrocephalus and VP shunt done 3 months back. Subsequently, the child was treated for post-shunt meningitis and peritonitis. She presented with abdominal pain and extrusion of a tube like structure form the anal orifice after passing stool, which was clinically diagnosed as migrated VP shunt tube (Fig.3). She had wide open, full anterior fontanel and patent VP shunt. Laparotomy was done to reposition the tube and the distal end was cut and extruded out per rectally.

Fig. 3 Extrusion of VP shunt through the rectum.