Online edition:ISSN 2758-089X

Acute Appendicitis Due to a Ventriculoperitoneal Shunt ― Report of a case ―

A 66-year-old woman presented to our clinic with a chief complaint of acute right lower abdominal pain in February 1992. She had undergone a ventriculoperitoneal shunt four months prior to this admission for communicating hydrocephalus, which was associated with subarachnoid hemorrhage due to a ruptured aneurysm of the right middle cerebral artery. The abdomen was tender over the right lower quadrant, with signs of peritonitis. On the day of admission, an abdominal exploration was done using a lower midline incision under general anesthesia. On entering the peritoneal cavity, a small amount of fluid was noticed. The shunt catheter was traced to the right paracolic space next to the appendix. Acute phlegmonous appendicitis was noted, and an appendectomy was performed. The peritoneal cavity was irrigated with saline, after which the shunt catheter was exteriorized. The patient's postoperative course was uneventful. Culture studies of the cerebrospinal fluid were negative, and culture studies of the ascites revealed Esherichia coli. Histological examination showed the serosa of the appendix to be inflamed with no obstruction of the lumen. These findings suggest that the shunt catheter may have caused the inflammation of the appendix.

Nishina M, et al