Appendicitis in children with a ventriculoperitoneal shunt.

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.