{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T10:08:08Z","timestamp":1779444488257,"version":"3.53.1"},"reference-count":22,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and clinical significance: Catheter knotting is a rare but potentially serious complication of urethral catheterization in neonates and infants, particularly when feeding tubes are used due to small urethral caliber. Case Presentation: We report the case of a 6-month-old male infant with Crouzon syndrome who underwent cranioplasty. Intraoperatively, a 6 Fr feeding tube was inserted for bladder drainage. On postoperative day 6, resistance was encountered during catheter removal. Radiography revealed a double knot in the distal urethra and a single knot in the proximal urethra. The catheter was successfully removed surgically via cystotomy, and the infant recovered uneventfully with normal voiding function. Conclusions: This case demonstrates the exceptional occurrence of simultaneous double and single knots in a urinary catheter. Awareness of this rare complication, careful control of insertion length, and prompt intervention upon resistance are essential to prevent urethral trauma and ensure patient safety.<\/jats:p>","DOI":"10.3390\/reports9020165","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T09:17:09Z","timestamp":1779441429000},"page":"165","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spontaneous Multiple Knotting of a Feeding Tube Urinary Catheter in an Infant with Crouzon Syndrome: A Case Report"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5591-596X","authenticated-orcid":false,"given":"Konstantinos","family":"Gkialas","sequence":"first","affiliation":[{"name":"Department of Urology, General Children\u2019s Hospital \u201cAgia Sofia\u201d, Thivon 1 & Papadiamantopoulou, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9372-155X","authenticated-orcid":false,"given":"Anna","family":"Papakonstantinou","sequence":"additional","affiliation":[{"name":"Department of Urology, General Children\u2019s Hospital \u201cAgia Sofia\u201d, Thivon 1 & Papadiamantopoulou, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Deligiannis","sequence":"additional","affiliation":[{"name":"Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4651-312X","authenticated-orcid":false,"given":"Aris","family":"Kaltsas","sequence":"additional","affiliation":[{"name":"Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Mitsos","sequence":"additional","affiliation":[{"name":"Department of Urology, General Children\u2019s Hospital \u201cAgia Sofia\u201d, Thivon 1 & Papadiamantopoulou, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e365","DOI":"10.5001\/omj.2022.05","article-title":"Spontaneous Intravesical Knotting of a Feeding Tube in a Late Preterm Neonate: A Case Report","volume":"37","author":"Abuanza","year":"2022","journal-title":"Oman Med. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1017\/S1481803500006229","article-title":"Urethral Catheter Knotting: Be Aware and Minimize the Risk","volume":"4","author":"Arena","year":"2002","journal-title":"Can. J. Emerg. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1159\/000096335","article-title":"Spontaneous Knotting of Urinary Catheters: Clinical and Experimental Observations","volume":"77","author":"Raveenthiran","year":"2006","journal-title":"Urol. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1016\/S0022-5347(17)36948-3","article-title":"Adventitious Knots in Urethral Catheters: Report of 5 Cases","volume":"148","author":"Foster","year":"1992","journal-title":"J. Urol."},{"key":"ref_5","first-page":"e93216","article-title":"Difficulty Removing a Urethral Catheter in a Boy Due to a \u201cHairpin-Fold\u201d Deformity: A Case Report","volume":"17","author":"Kawano","year":"2025","journal-title":"Cureus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"368504231156297","DOI":"10.1177\/00368504231156297","article-title":"Craniofacial Characteristics in Crouzon\u2019s Syndrome: A Systematic Review and Meta-Analysis","volume":"106","author":"Alam","year":"2023","journal-title":"Sci. Prog."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e5296","DOI":"10.1097\/GOX.0000000000005296","article-title":"Crouzon Syndrome Spanning Three Generations: Advances in the Treatment of Syndromic Midface Deficiency","volume":"11","author":"Harmon","year":"2023","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1016\/j.asjsur.2022.02.015","article-title":"The Diagnosis and Treatment of Infant Crouzon Syndrome with Literature Review","volume":"45","author":"Yuan","year":"2022","journal-title":"Asian J. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.jcms.2021.11.008","article-title":"Algorithm to the Treatment of Crouzon Syndrome","volume":"50","author":"Raffaini","year":"2022","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/0090-4295(83)90327-8","article-title":"Knot in Urethral Catheter Due to Improper Catheterization Technique","volume":"22","author":"Sugar","year":"1983","journal-title":"Urology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/PEC.0000000000003129","article-title":"The Knotted Urethral Catheter-Description of a Novel Technique and Steps for Removal","volume":"40","author":"Rampersad","year":"2024","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"40","DOI":"10.4103\/1596-3519.108250","article-title":"Spontaneous Knotting of a Feeding Tube in the Bladder","volume":"12","author":"Eke","year":"2013","journal-title":"Ann. Afr. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S0022-5347(17)58897-7","article-title":"Guide Wire Manipulation of Knot in a Catheter Used for Cystourethrography","volume":"116","author":"Harris","year":"1976","journal-title":"J. Urol."},{"key":"ref_14","first-page":"103420","article-title":"Self-Knotting Catheter Post Urethroplasty: A Case Report","volume":"66","author":"Sugianto","year":"2026","journal-title":"Urol. Case Rep."},{"key":"ref_15","first-page":"631","article-title":"Urethral Catheter Knotting in Preterm Neonates","volume":"41","author":"Anbu","year":"2004","journal-title":"Indian Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"443","DOI":"10.4103\/UA.UA_15_19","article-title":"Spontaneous Knotting of Urinary Catheters Placed with Nonindwelling Intent: Case Series and Literature Review","volume":"11","author":"Singh","year":"2019","journal-title":"Urol. Ann."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"bcr2017221498","DOI":"10.1136\/bcr-2017-221498","article-title":"Knotted Urethral Catheter: An Unusual Complication in Adults","volume":"2017","author":"Jallad","year":"2017","journal-title":"BMJ Case Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/j.1744-6155.1997.tb00198.x","article-title":"Standards to Prevent Complications of Urinary Catheterization in Children: Should and Should-Knots","volume":"2","author":"Carlson","year":"1997","journal-title":"J. Soc. Pediatr. Nurs."},{"key":"ref_19","first-page":"185","article-title":"Choosing the Right Catheter for Pediatric Procedures: Patient Considerations and Preference","volume":"13","author":"Crigger","year":"2021","journal-title":"Res. Rep. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"620.e1","DOI":"10.1016\/j.jpurol.2023.06.006","article-title":"Can We Predict Urethral Length of Boys?-An Observational Study","volume":"19","author":"Sreekanth","year":"2023","journal-title":"J. Pediatr. Urol."},{"key":"ref_21","first-page":"55","article-title":"Urinary Catheterization in Infants: When It\u2019s Knot so Simple","volume":"2","author":"Sheridan","year":"2018","journal-title":"Clin. Pract. Cases Emerg. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/00006565-198903000-00012","article-title":"Knotting of a Bladder Catheter","volume":"5","author":"Kanengiser","year":"1989","journal-title":"Pediatr. Emerg. Care"}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/165\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T09:57:05Z","timestamp":1779443825000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["reports9020165"],"URL":"https:\/\/doi.org\/10.3390\/reports9020165","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]}}}