An unusual ventriculoperitoneal shunt complication: spontaneous knot formation

Börcek, Alp Özgün; Çivi, Soner; Goleń, M.; Emmez, Hakan; Baykaner, M. Kemali

doi:10.5137/1019-5149.jtn.3506-10.0

Cited by 10 publications

(26 citation statements)

References 7 publications

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“…The formation of a knot in a peritoneal catheter commonly results in VP shunt malfunction [3, 9, 11–13]. Knotting of the catheter around the bowel can lead to bowel obstruction and gangrene [4, 14].…”

Section: Discussionmentioning

confidence: 99%

“…The abdominal complications of VP shunt insertion include cerebrospinal fluid (CSF) ascites, loculated cysts, hydrocele, infection, shunt extrusion, shunt migration, CSF leaks, viscous perforations, and protrusion of the catheter from the anus [1, 2]. Spontaneous knotting of the peritoneal catheter is a rare complication of the VP shunt [3]. Here, we report a case of knotting of the peritoneal catheter discovered during the removal of a malfunctioning VP shunt.…”

Section: Introductionmentioning

confidence: 99%

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Ventriculoperitoneal Shunt Peritoneal Catheter Knot Formation

Ulhaq

Al-Shanafey

Sabbagh

et al. 2013

Case Reports in Neurological Medicine

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The ventriculoperitoneal (VP) shunt is a common procedure in pediatric neurosurgery that carries a risk of complications at cranial and abdominal sites. We report on the case of a child with shunt infection and malfunction. The peritoneal catheter was tethered within the abdominal cavity, precluding its removal. Subsequently, laparoscopic exploration identified a knot at the distal end of the peritoneal catheter around the omentum. A new VP shunt was inserted after the infection was healed. This type of complication occurs rarely, so there are a limited number of case reports in the literature. This report is complemented by a literature review.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ventriculoperitoneal Shunt Peritoneal Catheter Knot Formation

Ulhaq

Al-Shanafey

Sabbagh

et al. 2013

Case Reports in Neurological Medicine

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“…4,6,9,10,[13][14][15][16]18,[20][21][22] Bowel ischemia and necrosis due to strangulation of intestines by the knotted peritoneal catheter can occur, and this complication is exceedingly rare, with only 1 case previously reported in the literature. 18 The case reported here represents only the second occurrence of bowel necrosis caused by a knotted distal shunt catheter.…”

Section: Discussionmentioning

confidence: 99%

“…5,7,11,19 Knotting of the distal catheter is very rare but generally present with a shunt block and subsequent malfunction, which often only require simple distal revisions. 4,6,9,10,[13][14][15][16]18,[20][21][22] Small-bowel necrosis due to knotting of the peritoneal catheter is an exceedingly rare complication of a VPS, with only 1 previously described case in the literature. 18 We report only the second case of bowel necrosis due to knotting of peritoneal catheter, and we provide a comprehensive review of the literature while considering the clinical relevance of this rare complication.…”

confidence: 99%

Ventriculoperitoneal shunt with a rare twist: small-bowel ischemia and necrosis secondary to knotting of peritoneal catheter

Tan¹,

Kasliwal²,

Moftakhar³

et al. 2014

PED

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Small-bowel ischemia and necrosis due to knotting of the peritoneal catheter is an extremely rare complication related to a ventriculoperitoneal shunt (VPS). A 3-month-old girl, with a history of Chiari II malformation and myelomeningocele (MM) after undergoing right occipital VPS insertion and MM repair at birth, presented to the emergency department with a high-grade fever. Examination of a CSF sample obtained via shunt tap raised suspicion for the presence of infection. Antibiotic therapy was initiated, and subsequently the VPS was removed and an external ventricular drain was placed. Intraoperatively, as attempts at pulling the distal catheter from the scalp incision were met with resistance, the distal catheter was cut and left in the abdomen while the remainder of the shunt system was successfully removed. While the patient was awaiting definitive shunt revision surgery to replace the VPS, she developed abdominal distension due to small-bowel obstruction. An emergency exploratory laparotomy revealed a knot in the distal catheter looping around and strangulating the distal ileum, causing small-bowel ischemia and necrosis in addition to the obstruction. A small-bowel resection with ileostomy was performed, with subsequent placement of ventriculoatrial shunt for treatment of hydrocephalus. The authors report this exceedingly rare clinical scenario to highlight the fact that any retained distal catheter must be carefully managed with immediate abdominal exploration to remove the distal catheter to avoid bowel necrosis as pulling of a knotted peritoneal catheter may strangulate the bowel and cause ischemia, with significant clinical morbidity and possible mortality.

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“…A derivação ventriculoperitoneal (DVP) é o procedimento cirúrgico mais usado no tratamento dos distúrbios da circulação do liquido cefalorraquidiano (LCR) 1,10,12 . Várias complicações podem ocorrer deste procedimento cirúrgico como: infecção, obstrução, desconexão e extrusão do sistema 1,10 . A ocorrência de nó no cateter peritoneal é considerada rara [1][2][3][4]6,7,11,12 .…”

Section: Introductionunclassified

Complicação Rara de Mau Funcionamento de DVP

Pereira¹,

Morais²

2018

jbnc

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RESUMOA derivação ventriculoperitoneal (DVP) tem sido o tratamento cirúrgico de escolha mais comum no controle da hidrocefalia. Este procedimento não é isento de complicações. O nó espontâneo no cateter peritoneal tem sido considerado uma complicação rara. O mecanismo exato desta complicação permanece desconhecido. Dentre as prováveis causas desta complicação estão peristaltismo intestinal, elasticidade do material do shunt, comprimento do cateter e técnica cirúrgica. Os autores relatam um caso de nó espontâneo no cateter peritoneal em uma criança que apresentou hipertensão intracraniana, sendo submetida a retirada do sistema e instalação de um novo cateter, que cursou com bom prognóstico. Palavras-chave: Derivação ventriculoperitoneal; Complicação de shunt; Mau funcionamento de shunt; Nó cateter peritoneal;ABSTRACT The ventriculoperitoneal shunt (VPS ) has been the choice surgical treatment in controlling hydrocephalus. This procedure is not without complications. The Spontaneous node in the peritoneal catheter has been considered a rare complication. The exact mechanism of this complication remains unknown. Among the probable causes of this complication are intestinal peristalsis, the shunt material elasticity, the catheter length and surgical technique. The authors report a case of spontaneous node in the peritoneal catheter in a child who had intracranial hypertension, and subjected to removal of the system and installation of a new catheter, which he attended with a good prognosis.

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An unusual ventriculoperitoneal shunt complication: spontaneous knot formation

Cited by 10 publications

References 7 publications

Ventriculoperitoneal Shunt Peritoneal Catheter Knot Formation

Ventriculoperitoneal Shunt Peritoneal Catheter Knot Formation

Ventriculoperitoneal shunt with a rare twist: small-bowel ischemia and necrosis secondary to knotting of peritoneal catheter

Complicação Rara de Mau Funcionamento de DVP

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