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Ventriculoperitoneal shunt infection masquerading as an acute surgical abdomen
Insights
Ventriculoperitoneal shunts treat hydrocephalus in children. Infected shunts can mimic appendicitis, but removing the shunt and using antibiotics resolves symptoms, avoiding unnecessary surgery.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Infectious Disease
Background:
- Ventriculoperitoneal (VP) shunts are crucial for managing pediatric hydrocephalus.
- Shunt infections are a serious complication requiring prompt diagnosis and treatment.
Observation:
- Nineteen children with VP shunts presented with symptoms of acute peritonitis, including abdominal pain, fever, and tenderness.
- Some cases were misdiagnosed as appendicitis, leading to unnecessary laparotomies and complications.
Findings:
- Infected VP shunts caused peritonitis in pediatric patients.
- A conservative management approach involving shunt removal, antibiotics, and external ventricular drainage was effective.
- This strategy successfully treated abdominal symptoms and prevented further surgical interventions.
Implications:
- This approach can prevent unnecessary exploratory surgeries in children with VP shunt infections.
- Effective management of shunt infections improves patient outcomes and reduces healthcare costs.
- Highlights the importance of considering shunt complications in the differential diagnosis of abdominal pain in children with hydrocephalus.
Abstract:
Shunting of cerebrospinal fluid to the peritoneal cavity has brightened the outlook for children with hydrocephalus. Nine hundred sixty-nine primary ventriculoperitoneal shunts were inserted for hydrocephalus between 1970 and 1981. During this same period, 2205 shunt revisions were performed in 847 children, some of whose primary shunt had been inserted prior to 1970 or at other institutions. Nineteen patients with a ventriculoperitoneal shunt infection persented with abdominal pain, fever, and abdominal tenderness; each had acute peritonitis. Three underwent laparotomy with the preoperative diagnosis of appendicitis; however, only infected peritoneal fluid and nonobstructing adhesions were found. A fourth child underwent an unnecessary intestinal resection at another hospital and required prolonged nutritional support and treatment of severe postoperative complications. Fifteen children who presented with an "acute surgical abdomen" were managed with intravenous fluids, gastric decompression, antibiotics, and removal of the intraperitoneal shunt. External ventricular drainage was employed until the cerebrospinal fluid was sterile. The shunt was then internalized in the peritoneal cavity. The abdominal signs and symptoms improved after removing the peritoneal tubing in all children. This plan of therapy has eliminated unnecessary laparotomy in those who may require repeated procedures for control of hydrocephalus.