Ventriculoperitoneal shunt infection masquerading as an acute surgical abdomen

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. Nine-teen 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.