The shadow in the darkness: Case report on adhesive intestinal obstruction secondary to ventriculoperitoneal shunt catheter in an elderly patient

Closed-Loop Bowel Obstruction Induced by Ventriculoperitoneal Shunt Catheter Coiling at the Sigmoid Colon: A Case Report

Intestinal obstruction is a rarely encountered complication in patients with ventriculoperitoneal (VP) shunt. The most common causes of bowel obstruction in this subset of patients include volvulus, formation of a spontaneous knot, and adhesions. Herein, we report a 21-year-old bedridden male with a history of congenital hydrocephalus on VP shunt, spina bifida, neurogenic bladder, and paraplegia who presented with a seven-day history of abdominal discomfort, distention, constipation, vomiting, and intolerance to oral intake. Abdominal x-ray showed dilated bowel loops. Computed tomography (CT) of the abdomen demonstrated a closed-loop bowel obstruction at the level of the sigmoid colon caused by the coiling of the VP shunt catheter. Diagnostic laparoscopy revealed the VP shunt tube coiling around a segment of the sigmoid colon with no signs of bands, ischemia, or perforation. Pulling and shortening of the tube was done. The procedure went uneventfully, and the patient was discharged home in stable condition. Maintaining a high index of suspicion for knotting the peritoneal catheter around the bowel is crucial when a patient on a VP shunt presents with a picture suggestive of intestinal obstruction. Early surgical intervention might be required to prevent further progression and complications.