title: Ventriculoperitoneal shunt knot: a rare cause of bowel obstruction and ischemia.
abstract: 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.
authors.affiliation: Department of Surgery, Queen's University, Kingston, Ont.
authors.forename: Y
authors.initials: Y
authors.lastname: Starreveld
authors.forename: D
authors.initials: D
authors.lastname: Poenaru
authors.forename: P
authors.initials: P
authors.lastname: Ellis
mesh_terms: D003616:Dandy-Walker Syndrome / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000209:etiology*; D007421:Intestine, Small / Q000098:blood supply*; D007511:Ischemia / Q000209:etiology*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000295:instrumentation