Appendicitis and Presence of a Ventriculoperitoneal (VP) Shunt

Appendicitis can cause ventriculoperitoneal (VP) shunt infection. However, little data is available on the incidence of shunt infections and shunt revisions with appendicitis. Therefore, we sought to determine the rates of shunt infection and revision in patients with VP shunt and appendicitis using large database data and review the literature.

We used a de-identified database network (TriNetX) to retrospectively query via ICD-10 and current procedural terminology codes to evaluate all patients with the presence of a VP shunt and appendicitis. Primary outcomes included shunt infection and shunt revision at 90 days, with secondary outcomes of sepsis and seizure.

396 patients with VP shunt and subsequent appendicitis were identified. The average age was 27.02+-20.94 years. Shunt infection was identified in 43 (10.859%) patients within 90 days of appendicitis, and shunt externalization or revision was performed in 66 (16.667%) patients. Sepsis was identified in 49 (12.374%) patients and seizures occurred in 56 (14.141%) patients. The literature review revealed eight relevant articles, with 49 total patients. Ten (20.408%) patients had shunts externalized, four of which occurred after shunt infection was identified. Shunt infection occurred in a total of 11 (22.449%) patients. Two (4.082%) patients died, one of which had their shunt externalized pre-emptively, and the other after ventriculitis was identified. Shunt revisions were performed in 16 (32.653%) Conclusion: Our results demonstrate that shunt externalization should be strongly considered in patients with appendicitis, given high shunt infection rates.