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Does appendicitis in a child with a ventriculoperitoneal shunt necessitate shunt revision?
  1. Peter D Johnstone1,
  2. Jayaratnam Jayamohan2,
  3. Dominic F Kelly1,
  4. Simon B Drysdale1
  1. 1 Department of Paediatrics, University of Oxford, Oxford, UK
  2. 2 Neurosurgery Department, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Simon B Drysdale, Paediatrics, University of Oxford, Oxford OX1 2JD, UK; simon.drysdale{at}paediatrics.ox.ac.uk

https://doi.org/10.1136/archdischild-2018-316265

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    Question

    In children with a ventriculoperitoneal (VP) shunt in situ, is shunt externalisation of the abdominal portion mandatory in acute appendicitis?

    Case vignette

    A boy aged 8 years with a long-term VP shunt presented to the emergency department with right iliac fossa pain, nausea and vomiting. Abdominal ultrasound showed likely appendicitis. We wondered whether, in a child with a VP shunt in situ with appendicitis, the shunt should always be removed and what antibiotic regimen should be used?

    Search

    PubMed: ‘ventriculoperitoneal’ AND ‘shunt’ AND ‘appendicitis’ OR ‘peritonitis’

    Returned 89 results—of these 6 were relevant to our question. Other articles were excluded as they focused on bowel pathologies other than appendicitis, only included patients with primary VP shunt problems and were evaluating different surgical techniques.

    Commentary

    This systematic review demonstrates there are only a limited number of cases reported …

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