Purpose: 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. Conclusion: 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.
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