A rare case of ventriculoperitoneal shunt knot causing intestinal obstruction in an adult

Abstract

Only 15 cases of intraperitoneal knot formation causing intestinal obstruction to have been described. So here ABSTRACT Despite high incidence of complications, Ventriculoperitoneal shunting for hydrocephalus is the cornerstone and the most common neurosurgical procedure. Ventriculoperitoneal shunt knot causing intestinal obstruction is an extremely rare complication needing surgical intervention. A 19 years old male with history of VP shunting in infancy for hydrocephalus with no history of any revision surgery presented in emergency with pain abdomen and multiple episodes of vomiting for 2 days. X ray showed dilated bowel loops with a coiled up VP shunt in the abdomen. Exploratory laparotomy showed multiple dilated bowel loops with a loop of VP shunt around ileal segment with dense fibrotic adhesions causing obstruction. Extensive adhesiolysis was done. Procedure underwent uneventful. Patient recovered swiftly in postoperative period and is currently asymptomatic after 6 months of surgery. Improved surgery skills and shunt design have prevented much of the morbidity of VP shunting. Most of the cases reported earlier were paediatric patients with history of repetitive handling of catheter. We believe this to be the first case of intestinal obstruction by a VPS knot in an adult with no history of manipulation after primary surgery. Due to low incidence it is difficult to clinically suspect such an extremely rare complication. Therefore, an awareness of VP shunt related complications in adult is essential.

Bowel Obstruction Secondary to Spontaneous Knot Formation of Ventriculoperitoneal Shunt

“…These signs include vomiting, abdominal pain/discomfort, abdominal distention, and radiography with suspicion of obstruction following difficult shunt removal or resistance during manipulation [11]. This case report presents one of only four cases in the older pediatric/adult population at the time of the literature review [3,6,8].…”

“…Spontaneous knot formation of the catheter is extremely rare, and subsequent bowel obstruction and/or necrosis is even rarer [4,6,7]. With only three additional cases reported in the pediatric population, most of these cases occurred in patients with a history of repetitive manipulation of the catheter [3,6,8]. This case report adds to the knowledge of the VP catheter knot formation and its laparoscopic treatment.…”

“…Despite the routine use of VP shunts, the most common complications involving the abdomen include ascites due to cerebrospinal fluid (CSF) leaks, hydrocele formation, infection, shunt migration and extrusion, and formation of loculated cysts [2]. Spontaneous knot formation of the catheter is extremely rare, and subsequent bowel obstruction and/or necrosis is even rarer [4,6,7]. With only three additional cases reported in the pediatric population, most of these cases occurred in patients with a history of repetitive manipulation of the catheter [3,6,8].…”

Closed-Loop Bowel Obstruction Induced by Ventriculoperitoneal Shunt Catheter Coiling at the Sigmoid Colon: A Case Report

“…Only one case described a VP shunt inserted in a pediatric patient, with multiple shunt revisions for recurrent hydrocephalus, where a knot formation manifested in adulthood with small intestinal obstruction [ 16 ]. Another case reported bowel obstruction caused by knotting of the VP shunt in an adult patient who had the shunt placement during infancy with no subsequent manipulation [ 17 ].…”

“…Knotting of the peritoneal catheter around the bowel should be considered when the patient presents with signs and symptoms of intestinal obstruction [ 2 ]. Early surgical intervention might be warranted to prevent further progression and complications [ 17 ].…”