Spontaneous Multiple Knotting of a Feeding Tube Urinary Catheter in an Infant with Crouzon Syndrome: A Case Report.

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.