title: Appendicitis in the child with a ventriculo-peritoneal shunt: a 30-year review.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8. a_ein@istar.ca
authors.forename: Sigmund H
authors.initials: SH
authors.lastname: Ein
authors.forename: Steven
authors.initials: S
authors.lastname: Miller
authors.forename: James T
authors.initials: JT
authors.lastname: Rutka
mesh_terms: D000293:Adolescent; D001064:Appendicitis / Q000453:epidemiology / Q000601:surgery*; D002493:Central Nervous System Diseases / Q000453:epidemiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012086:Reoperation; D017287:Ventriculoperitoneal Shunt