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Acute abdomen in children with infected ventriculoperitoneal shunts
Insights
Infected ventriculoperitoneal shunts can mimic abdominal emergencies in children. Prompt diagnosis via ventricular fluid analysis and antibiotic treatment are crucial for effective management and preventing complications.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Neurosurgery
Background:
- Ventriculoperitoneal shunts are common in pediatric neurosurgery.
- Shunt infections can present with atypical symptoms, including abdominal emergencies.
- Misdiagnosis can lead to delayed treatment and surgical complications.
Purpose of the Study:
- To describe a syndrome of infected ventriculoperitoneal shunts presenting as acute abdominal emergencies.
- To highlight the diagnostic challenges and emphasize the importance of early recognition.
- To outline an effective management strategy for this condition.
Main Methods:
- Retrospective analysis of seven pediatric patients with infected ventriculoperitoneal shunts.
- Evaluation of clinical presentation, diagnostic methods, and treatment outcomes.
- Analysis of cerebrospinal fluid (CSF) obtained from shunt reservoirs.
Main Results:
- Seven children presented with acute abdominal symptoms without neurological signs.
- Diagnosis was confirmed by analysis of ventricular CSF from the shunt reservoir.
- Treatment involving CSF diversion, antibiotics, and shunt replacement led to complete recovery.
Conclusions:
- Infected ventriculoperitoneal shunts should be considered in the differential diagnosis of abdominal emergencies in children with shunts.
- Analysis of ventricular fluid is key to accurate and timely diagnosis.
- Prompt management with antibiotics and appropriate surgical intervention ensures favorable outcomes.
Abstract:
During the past 48 months, seven children with infected ventriculoperitoneal shunts with acute abdominal emergencies in the absence of neurological signs or symptoms were encountered. Initial confusion in the correct diagnosis led to unnecessary laparatomy in three children and a dangerous delay in the initiation of appropriate treatment in all seven patients. The correct diagnosis was made by analysis of ventricular fluid obtained from the shunt reservoir. Diversion of infected CSF from the inflamed peritoneal cavity combined with intravenous and intraventricular antibiotics resulted in prompt resolution of abdominal signs and successful sterilization of the CSF. Total shunt replacement in uncontaminated CSF followed by postoperative antibiotic therapy administered intravenously effected complete cures in all patients. Awareness of this syndrome and its proper management is of paramount importance.