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Appendicitis in children with a ventriculoperitoneal shunt
W Pumberger1, M Löbl, W Geissler
1Division of Pediatric Surgery, University of Vienna, Austria.
Insights
Children with ventriculoperitoneal shunts presenting with acute abdomen need careful diagnosis. Appendicitis is a key consideration, and prompt ultrasound aids in timely surgical intervention while preserving the shunt.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Gastroenterology
Background:
- Ventriculoperitoneal shunts are common in children but can complicate acute abdominal presentations.
- Differentiating shunt-related issues from primary abdominal pathology is crucial for effective management.
Purpose of the Study:
- To analyze the diagnostic challenges and outcomes of appendicitis in children with ventriculoperitoneal shunts.
- To evaluate the safety of maintaining ventriculoperitoneal shunts during abdominal surgery for appendicitis.
Main Methods:
- Retrospective analysis of medical records for 6 pediatric patients with ventriculoperitoneal shunts and appendicitis.
- Review of diagnostic methods including history, clinical examination, and abdominal ultrasound.
- Assessment of surgical management and postoperative complications.
Main Results:
- Appendicitis was successfully diagnosed and treated surgically in 6 children with ventriculoperitoneal shunts.
- Abdominal ultrasound proved valuable in diagnosis, enabling prompt surgical intervention.
- Shunts were generally maintained during surgery; one patient required conversion to a ventriculoatrial shunt due to a postoperative pseudocyst.
Conclusions:
- Primary intra-abdominal diseases like appendicitis in children with ventriculoperitoneal shunts require surgical treatment, with shunt preservation being feasible.
- Shunt infection necessitates conservative management and shunt removal, avoiding laparotomy.
- Accurate diagnosis relies on thorough history, clinical assessment, and especially abdominal ultrasound.
Abstract:
The presentation of an acute abdomen in children with a ventriculoperitoneal shunt requires skillful diagnostic workup. Apart from complications caused by the shunt, primary abdominal pathological conditions must be taken into consideration, particularly in the older child. A series of 6 children with a ventriculoperitoneal shunt had to be treated surgically for appendicitis. Their medical records were analyzed retrospectively. Despite difficulties with the initial diagnosis, the time from admission to final diagnosis and operation was relatively short. An accurate history, careful evaluation of the clinical signs and, above all, ultrasound of the abdomen were helpful in decision making. During the operation the shunts were left in place. Only 1 patient developed a cerebrospinal fluid pseudocyst in the early postoperative period, which made a conversion into a ventriculoatrial shunt necessary. No ascending infection occurred, even when the abdominal tip of the shunt came in close contact with the focus of inflammation. An acute abdomen due to shunt infection should be managed conservatively and by removal of the shunt from the abdomen, thus avoiding an unnecessary laparotomy. On the other hand, a primary intraabdominal disease requires surgical treatment, during which the shunt system can be left in place.
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