Ventriculoperitoneal shunt knot: a rare cause of bowel obstruction and ischemia

Small-bowel obstruction caused by knotting of a peritoneal shunt catheter is an extremely rare and severe complication of a ventriculoperitoneal (VP) shunt. In the 1-week-old female infant reported here who had a VP shunt, inability to remove the peritoneal catheter was followed by small-bowel obstruction and necrosis due to intestinal strangulation in a tight loop of the catheter. An uncomplicated primary resection of the necrotic segment was followed by placement of a temporary ventriculoatrial shunt. The authors suggest that when withdrawal of the peritoneal part of a VP shunt meets with resistance, an intraoperative radiograph should be obtained to assess the position of the remaining catheter. If knotting is observed, an attempt to straighten the catheter with a guide wire is worthwhile. Should this fail, immediate laparoscopy or laparotomy is indicated.