A rare case of ventriculoperitoneal shunt knot causing intestinal obstruction in an adult
DOI:
https://doi.org/10.18203/2349-2902.isj20190423Keywords:
Adult, Intestinal obstruction, VP shunt, VPS knotAbstract
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.
References
Kiat A, Wright DB, Rebello IG. Intraperitoneal knotting of a ventriculoperitoneal shunt causing small bowel obstruction in an adult. ANZ J Surg. 2018 Jan;88(1-2):E71-2.
Sanan A, Haines SJ, Nyberg SL, Leonard AS. Knotted bowel: small-bowel obstruction from coiled peritoneal shunt catheters. Report of two cases. J Neurosurg. 1995 Jun;82(6):1062-4.
Tan LA, Kasliwal MK, Moftakhar R, Munoz LF. Ventriculo peritoneal shunt with a rare twist: small-bowel ischemia and necrosis secondary to knotting of peritoneal catheter. J Neurosurg Pediatr. 2014 Sep;14(3):234-7.
Chung JJ, Yu JS, Kim JH, Nam SJ, Kim MJ. Intraabdominal complications secondary to ventriculoperitoneal shunts: CT findings and review of the literature. Am J Roentgenol. 2009 Nov;193(5):1311-7.
Murtagh FR, Quencer RM, Poole CA. Extracranial complications of cerebrospinal fluid shunt function in childhood hydrocephalus. Am J Roentgenol. 1980 Oct 1;135(4):763-6.
Starreveld Y, Poenaru D, Ellis P. Ventriculoperitoneal shunt knot: a rare cause of bowel obstruction and ischemia. Can J Surg. 1998 Jun;41(3):239-40.
Mohammed W, Wiig U, Caird J. Spontaneous knot; a rare cause of ventriculoperitoneal shunt blockage. Br J Neurosurg. 2011 Feb;25(1):113-4.
Zhao R, Shi W, Yu J, Gao X, Li H. Complete intestinal obstruction and necrosis as a complication of a ventriculoperitoneal shunt in children: a report of 2 cases and systematic literature review. Medicine. 2015 Aug;94(34):e1375.
Weprin BE, Swift DM. Complications of ventricular shunts. Tech. Neurosurg. 2002;7:224-42.
de Aquino HB, Carelli EF, Neto AG, Pereira CU. Nonfunctional abdominal complications of the distal catheter on the treatment of hydrocephalus: an inflammatory hypothesis?. Child's Nervous System. 2006 Oct 1;22(10):1225-30.
Eftekhar B, Hunn A: Ventriculoperitoneal shunt blockage due to spontaneous knot formation in the peritoneal catheter. J Neurosurg Pediatr. 2008;1:142-3.
Mohindra S, Sharma M. Spontaneous knotting of peritoneal catheter: a report of an asymptomatic patient. J Pediat Neurosci. 2012 May;7(2):151-3.
Pandey A, Gangopadhyay AN, Sharma SP, Upadhyaya VD, Kumar V, Gopal SC, et al. Placement of the peritoneal end of a ventriculoperitoneal shunt in the suprahepatic space: does it improve prognosis?. Pediatr Neurosurg. 2009;45(1):6-10.
