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Appendicitis in the child with a ventriculo-peritoneal shunt: a 30-year review
Sigmund H Ein1, Steven Miller, James T Rutka
1Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8. a_ein@istar.ca
Insights
Acute appendicitis rarely occurs in children with ventriculo-peritoneal (VP) shunts. Imaging confirms diagnosis, and ruptured appendices require temporary shunt exteriorization.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neurosurgery
Background:
- Appendicitis and ventriculo-peritoneal (VP) shunts are common in children.
- Primary peritonitis occurs in 8-12% of VP shunt procedures.
- Differentiating appendicitis from VP shunt complications is crucial.
Purpose of the Study:
- To differentiate appendicitis from VP shunt-related peritonitis in children.
- To highlight the diagnostic challenges and management strategies.
Main Methods:
- Retrospective review of 8 pediatric cases with VP shunts and appendicitis (1973-2003).
- Clinical diagnosis in one case; ultrasonography and/or CT in the remaining seven.
- Surgical management included appendectomy and shunt exteriorization for ruptured appendices.
Main Results:
- Eight children with VP shunts were diagnosed with appendicitis (5 acute, 3 ruptured).
- Imaging modalities (ultrasound, CT) confirmed the diagnosis.
- All patients underwent appendectomy; 3 with ruptured appendices had temporary shunt exteriorization with no postoperative complications.
Conclusions:
- Acute appendicitis is a rare but possible diagnosis in children with VP shunts.
- Imaging is essential for accurate diagnosis.
- Temporary shunt exteriorization is necessary for ruptured appendices to prevent complications.
Purpose:
Each year, about 270 children are treated at our hospital for appendicitis, and there are 200 ventriculo-peritoneal (VP) shunt procedures. The incidence of primary peritonitis after a VP shunt is 8% to 12%. The purpose of this article is to try and differentiate these 2 entities.
Methods:
From 1973 to 2003 inclusive, appendicitis was diagnosed in 8 children with a VP shunt at our hospital; there were 7 boys and 1 girl with 5 acute appendicitis and 3 ruptured appendices. The first case was diagnosed on purely clinical grounds, whereas the last 7 were confirmed by ultrasonography and/or computed tomography.
Results:
All 8 had appendectomy and the shunt was exteriorized in the 3 children with a ruptured appendix. There were no postoperative problems, and the 8 children remained well.
Conclusion:
Acute appendicitis can and does rarely occur in children with VP shunts; however, in such situations, the correct diagnosis can be confirmed by imaging. The shunt must be temporarily exteriorized if the appendix is ruptured.
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