VENTRICULOPERITONEAL SHUNT KNOT - A RARE CAUSE OF BOWEL OBSTRUCTION AND ISCHEMIA

Small-bowel obstruction caused by knotting of a peritoneal shunt cathe ter is an extremely rare and severe complication of a ventriculoperito neal (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 strangulatio n in a tight loop of the catheter. An uncomplicated primary resection of the necrotic segment was followed by placement of a temporary ventr iculoatrial shunt. The authors suggest that when withdrawal of the per itoneal part of a VP shunt meets with resistance, an intraoperative ra diograph should be obtained to assess the position of the remaining ca theter. If knotting is observed, an at tempt to straighten the cathete r with a guide wire is worthwhile. Should this fail, immediate laparos copy or laparotomy is indicated.