{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T16:17:32Z","timestamp":1771863452125,"version":"3.50.1"},"reference-count":33,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,12,21]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>Knotting or twisting of the peritoneal catheter around a bowel segment, causing bowel obstruction and necrosis, is extremely rare. Only six cases have been reported in the literature. This report described the second case of an adult patient with spontaneous knotting of the peritoneal catheter around a small-bowel segment, causing bowel obstruction and necrosis. The presentation of a knotted ventriculoperitoneal shunt around a bowel loop is stereotypical. Treatment and general recommendations have been made to help guide clinicians when encountering such cases. Evidence of small-bowel obstruction in a twisted, coiled or knotted peritoneal catheter may need surgical intervention. In the setting of progressive abdominal manifestations, knotting of the peritoneal catheter around bowel loops may cause bowel obstruction and may present with acute life-threatening manifestations. Efficient and expedite diagnosis should be made to coordinate multispecialty intervention and follow-up appropriately.<\/jats:p>","DOI":"10.1136\/bcr-2020-239265","type":"journal-article","created":{"date-parts":[[2021,1,18]],"date-time":"2021-01-18T12:27:42Z","timestamp":1610972862000},"page":"e239265","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Ventriculoperitoneal shunt knotting causing bowel obstruction and necrosis in an adult patient"],"prefix":"10.1136","volume":"14","author":[{"given":"Orlando","family":"De Jesus","sequence":"first","affiliation":[{"name":"Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Rios-Vicil","sequence":"additional","affiliation":[{"name":"Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,18]]},"reference":[{"key":"2025082702423544000_14.1.e239265.1","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.inat.2018.04.004","article-title":"Ventriculoperitoneal shunt complications: a review","volume":"13","author":"Paff","year":"2018","journal-title":"Interdisciplinary Neurosurgery"},{"key":"2025082702423544000_14.1.e239265.2","doi-asserted-by":"crossref","first-page":"e129","DOI":"10.1016\/j.wneu.2018.06.140","article-title":"Abdominal complications of ventriculoperitoneal shunt in pediatric patients: experiences of a pediatric surgery clinic","volume":"118","author":"Burhan","year":"2018","journal-title":"World Neurosurg"},{"key":"2025082702423544000_14.1.e239265.3","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1007\/s00381-012-2004-5","article-title":"Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients","volume":"29","author":"Khan","year":"2013","journal-title":"Childs Nerv Syst"},{"key":"2025082702423544000_14.1.e239265.4","doi-asserted-by":"crossref","DOI":"10.4103\/2152-7806.151388","article-title":"Factors affecting ventriculoperitoneal shunt survival in adult patients","volume":"6","author":"Khan","year":"2015","journal-title":"Surg Neurol Int"},{"key":"2025082702423544000_14.1.e239265.5","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1227\/01.NEU.0000290903.07943.AF","article-title":"Ventriculoperitoneal shunt complications in California: 1990 to 2000","volume":"61","author":"Wu","year":"2007","journal-title":"Neurosurgery"},{"key":"2025082702423544000_14.1.e239265.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2013.01.096"},{"key":"2025082702423544000_14.1.e239265.7","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.135.4.763"},{"key":"2025082702423544000_14.1.e239265.8","first-page":"601","article-title":"Perforation of the bowel complicating peritoneal shunt for hydrocephalus. Report of two cases","volume":"32","author":"Wilson","year":"1966","journal-title":"Am Surg"},{"key":"2025082702423544000_14.1.e239265.9","first-page":"261","article-title":"An unusual ventriculoperitoneal shunt complication: spontaneous knot formation","volume":"22","author":"Borcek","year":"2012","journal-title":"Turk Neurosurg"},{"key":"2025082702423544000_14.1.e239265.10","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1007\/s00701-004-0320-6","article-title":"A knot in the catheter--an unusual cause of ventriculo-peritoneal shunt blockage","volume":"146","author":"Chopra","year":"2004","journal-title":"Acta Neurochir"},{"key":"2025082702423544000_14.1.e239265.11","doi-asserted-by":"crossref","first-page":"142","DOI":"10.3171\/PED\/2008\/1\/2\/142","article-title":"Ventriculoperitoneal shunt blockage due to spontaneous knot formation in the peritoneal catheter. Case report","volume":"1","author":"Eftekhar","year":"2008","journal-title":"J Neurosurg Pediatr"},{"key":"2025082702423544000_14.1.e239265.12","doi-asserted-by":"crossref","first-page":"113","DOI":"10.3109\/02688697.2010.534829","article-title":"Spontaneous knot; a rare cause of ventriculoperitoneal shunt blockage","volume":"25","author":"Mohammed","year":"2011","journal-title":"Br J Neurosurg"},{"key":"2025082702423544000_14.1.e239265.13","doi-asserted-by":"crossref","first-page":"151","DOI":"10.4103\/1817-1745.102587","article-title":"Spontaneous knotting of peritoneal catheter: a report of an asymptomatic patient","volume":"7","author":"Mohindra","year":"2012","journal-title":"J Pediatr Neurosci"},{"key":"2025082702423544000_14.1.e239265.14","first-page":"1","article-title":"Ventriculoperitoneal shunt peritoneal catheter knot formation","volume":"2013","author":"Ul-Haq","year":"2013","journal-title":"Case Rep Neurol Med"},{"key":"2025082702423544000_14.1.e239265.15","first-page":"231","article-title":"Ventriculoperitoneal shunt occlusion due to spontaneous intraabdominal knot formation in the catheter. Case report","volume":"105","author":"Woerdeman","year":"2006","journal-title":"J Neurosurg"},{"key":"2025082702423544000_14.1.e239265.16","doi-asserted-by":"publisher","DOI":"10.1007\/s003830050337"},{"key":"2025082702423544000_14.1.e239265.17","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-002-9063-8"},{"key":"2025082702423544000_14.1.e239265.18","doi-asserted-by":"crossref","first-page":"E71","DOI":"10.1111\/ans.13240","article-title":"Intraperitoneal knotting of a ventriculoperitoneal shunt causing small bowel obstruction in an adult","volume":"88","author":"Kiat","year":"2018","journal-title":"ANZ J Surg"},{"key":"2025082702423544000_14.1.e239265.19","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1159\/000488059","article-title":"If it's not broken, should we fix it? ventriculoperitoneal shunt catheter contributing to closed-loop small bowel obstruction in a pediatric patient with ileostomy","volume":"53","author":"Shakir","year":"2018","journal-title":"Pediatr Neurosurg"},{"key":"2025082702423544000_14.1.e239265.20","unstructured":"Sims DG , Chamberlain J . Small bowel obstruction following the insertion of a ventriculoperitoneal shunt. J R Coll Surg Edinb;1076:109\u201311."},{"key":"2025082702423544000_14.1.e239265.21","first-page":"43","article-title":"Intestinal obstruction caused by ventriculoperitoneal shunt knot. A case report","volume":"53","author":"Toshifumi","year":"2001","journal-title":"J Iwate Med Assoc"},{"key":"2025082702423544000_14.1.e239265.22","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1227\/00006123-199003000-00024","article-title":"Small bowel obstruction secondary to incomplete removal of a ventriculoperitoneal shunt: case report","volume":"26","author":"Hlavin","year":"1990","journal-title":"Neurosurgery"},{"key":"2025082702423544000_14.1.e239265.23","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.3171\/jns.1995.82.6.1062","article-title":"Knotted bowel: small-bowel obstruction from coiled peritoneal shunt catheters. Report of two cases","volume":"82","author":"Sanan","year":"1995","journal-title":"J Neurosurg"},{"key":"2025082702423544000_14.1.e239265.24","first-page":"239","article-title":"Ventriculoperitoneal shunt knot: a rare cause of bowel obstruction and ischemia","volume":"41","author":"Starreveld","year":"1998","journal-title":"Can J Surg"},{"key":"2025082702423544000_14.1.e239265.25","doi-asserted-by":"publisher","DOI":"10.3171\/2014.6.PEDS1418"},{"key":"2025082702423544000_14.1.e239265.26","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.medcli.2016.07.005","article-title":"[Ventriculo-peritoneal catheter knot with obstruction and intestinal necrosis: An unusual and serious complication]","volume":"147","author":"Mart\u00ednez Fern\u00e1ndez","year":"2016","journal-title":"Med Clin"},{"key":"2025082702423544000_14.1.e239265.27","doi-asserted-by":"crossref","first-page":"470","DOI":"10.3171\/2019.11.PEDS19138","article-title":"Ischemic bowel secondary to ventriculoperitoneal shunt knotting: a surprisingly rare complication of ventriculoperitoneal shunting. Case report","volume":"25","author":"Joy","year":"2020","journal-title":"J Neurosurg Pediatr"},{"key":"2025082702423544000_14.1.e239265.28","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000001375","article-title":"Complete intestinal obstruction and necrosis as a complication of a ventriculoperitoneal shunt in children: a report of 2 cases and systematic literature review","volume":"94","author":"Zhao","year":"2015","journal-title":"Medicine"},{"key":"2025082702423544000_14.1.e239265.29","doi-asserted-by":"crossref","DOI":"10.1227\/01.NEU.0000325261.29689.FC","article-title":"Intra-Abdominal vascular injury during trocar-assisted ventriculoperitoneal shunting: case report","volume":"63","author":"Danan","year":"2008","journal-title":"Neurosurgery"},{"key":"2025082702423544000_14.1.e239265.30","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/S0028-3770(05)83476-9","article-title":"Traumatisme spl\u00e9nique PAR cath\u00e9ter de d\u00e9rivation ventriculo-p\u00e9riton\u00e9ale","volume":"51","author":"Lubrano","year":"2005","journal-title":"Neurochirurgie"},{"key":"2025082702423544000_14.1.e239265.31","doi-asserted-by":"crossref","first-page":"552","DOI":"10.3109\/02688697.2012.657268","article-title":"Splenic laceration: an unusual complication of ventriculoperitoneal shunt","volume":"26","author":"Ashida","year":"2012","journal-title":"Br J Neurosurg"},{"key":"2025082702423544000_14.1.e239265.32","first-page":"1","article-title":"Iatrogenic haemoperitoneum requiring transfusion after ventriculoperitoneal shunt placement: case report","volume":"11","author":"Patel","year":"2020","journal-title":"Br J Neurosurg"},{"key":"2025082702423544000_14.1.e239265.33","doi-asserted-by":"crossref","DOI":"10.3171\/2012.7.FOCUS12179","article-title":"Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery","volume":"33","author":"Wong","year":"2012","journal-title":"Neurosurg Focus"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239265","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:42:49Z","timestamp":1756287769000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239265"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,18]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1136\/bcr-2020-239265"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239265","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}