Appendectomy for Appendicitis in Patients with a Prior Ventriculoperitoneal Shunt

Background

Approximately 18,000 cerebrospinal fluid shunts, the majority of which are ventriculoperitoneal, are placed each year in the United States. These patients may develop appendicitis and require surgery. Whether the risk of postoperative complications is increased in these patients is unknown. We sought to determine the clinical course of patients with ventriculoperitoneal (VP) shunts who undergo appendectomy for appendicitis.

Methods

A nationwide search of Department of Veterans Affairs databases was conducted to identify patients with a VP shunt who subsequently developed appendicitis and underwent appendectomy. Patient medical records were analyzed to determine if the presence of a VP shunt affected the surgical approach or the postoperative course of patients who underwent appendectomy.

Results

Ten patients had ICD-9-CM codes for both appendectomy and a VP shunt. Five met the inclusion criteria for the study and had sufficient data for analysis. Medical records indicated that all of the patients had perforated or gangrenous appendicitis with peritonitis. One patient’s VP shunt was converted to a ventriculoatrial shunt. Another patient’s shunt was removed when culture of his peritoneal fluid grew Gram-positive cocci. There were no instances of postoperative infection, shunt malfunction, or other complication.

Conclusion

This is the only English language study, to our knowledge, of the clinical course of adults with VP shunts in place at the time of appendectomy for appendicitis. Such patients generally have no complications related to shunt malfunction or infection. In a minority of patients, shunt revision may be required.

Key Words: ventriculoperitoneal shunt, appendectomy, hydrocephalus, appendicitis, outcomes