Hindawi Publishing Corporation Case Reports in Neurological Medicine Volume 2013, Article ID 628493, 4 pages http://dx.doi.org/10.1155/2013/628493 Case Report Ventriculoperitoneal Shunt Peritoneal Catheter Knot Formation Anwar Ul-Haq, 1 Faisal Al-Otaibi, 1,2 Saud Alshanafey, 2,3 Mohamed Diya Sabbagh, 2 and Essam Al Shail 1,2 1 Division of Neurosurgery, Neurosciences Department, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia 2 College of Medicine, Alfaisal University, King Faisal Specialist Hospital and Research Center, Riyadh 11533, Saudi Arabia 3 Division of Pediatric Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia Correspondence should be addressed to Faisal Al-Otaibi; faisalruwais@gmail.com Received 30 July 2013; Accepted 15 August 2013 Academic Editors: A. K. Demetriades and V. Wang Copyright © 2013 Anwar Ul-Haq et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. he ventriculoperitoneal (VP) shunt is a common procedure in pediatric neurosurgery that carries a risk of complications at cranial and abdominal sites. We report on the case of a child with shunt infection and malfunction. he peritoneal catheter was tethered within the abdominal cavity, precluding its removal. Subsequently, laparoscopic exploration identiied a knot at the distal end of the peritoneal catheter around the omentum. A new VP shunt was inserted ater the infection was healed. his type of complication occurs rarely, so there are a limited number of case reports in the literature. his report is complemented by a literature review. 1. Introduction Ventriculoperitoneal (VP) shunt insertion is one of the most common procedures performed in neurosurgical practice. he abdominal complications of VP shunt insertion include cerebrospinal luid (CSF) ascites, loculated cysts, hydrocele, infection, shunt extrusion, shunt migration, CSF leaks, vis- cous perforations, and protrusion of the catheter from the anus [1, 2]. Spontaneous knotting of the peritoneal catheter is a rare complication of the VP shunt [3]. Here, we report a case of knotting of the peritoneal catheter discovered during the removal of a malfunctioning VP shunt. he knotting of the catheter hindered its removal; the catheter was later removed laparoscopically. 2. Case Report his particular case refers to an eight-year-old boy who was born with a congenital hydrocephalus and large parieto- occipital skull defect. He underwent VP shunt insertion ater birth. He then underwent cranioplasty with titanium mesh and acrylic bone cement on January 20, 2009. One month later, he was presented to the emergency room with a severe headache and blurred vision. His ventricular catheter had migrated out of the ventricle, and the shunt was not functioning. An emergency external ventricular drain was inserted, which was replaced later with a VP shunt. A peritoneal catheter was inserted laparoscopically. Two years later, the boy returned with a headache, vomiting, fever, and seizures. he results of a CSF analysis indicated infection, and a Computed Tomography (CT) scan of his brain showed hydrocephalus, suggesting a shunt malfunction (Figure 1). A VP shunt X-ray series showed that the peritoneal catheter was coiled in the abdomen (Figure 2). He underwent removal of the VP shunt and insertion of an external ventricular drain. he ventricular catheter was removed easily prior to the insertion of the external drain. During removal, it was noted that the peritoneal catheter was diicult to remove and felt tethered at the abdominal entrance site. he upper part of the peritoneal catheter was cut and removed, and the remaining part was let in place to be dealt with later. Once the CSF infection cleared, the patient again underwent VP shunt insertion with the laparoscopic-assisted approach. During the procedure, it was noticed that there was a knot at the distal end of the peritoneal catheter, and the catheter was stuck at the inner surface of the abdominal wall near the point of its