- Department of Neurosurgery, Tone Central Hospital, Numata, Gunma, Japan
Department of Neurosurgery, Tone Central Hospital, Numata, Gunma, Japan
DOI:10.4103/sni.sni_420_16Copyright: © 2017 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Tomoaki Kano, Hideyuki Kawauchi. Fibrous encapsulation of the peritoneal catheter in peritoneal shunt: Case report. 27-Jun-2017;8:132
How to cite this URL: Tomoaki Kano, Hideyuki Kawauchi. Fibrous encapsulation of the peritoneal catheter in peritoneal shunt: Case report. 27-Jun-2017;8:132. Available from: http://surgicalneurologyint.com/surgicalint-articles/fibrous-encapsulation-of-the-peritoneal-catheter-in-peritoneal-shunt-case-report/
Background:The authors report a case of fibrous encapsulation of the peritoneal catheter, which caused peritoneal shunt malfunction, and has not previously been researched well as a complication of peritoneal shunts.
Case Description:A 69-year-old woman who had undergone a lumboperitoneal (LP) shunt for communicative hydrocephalus following subarachnoid hemorrhage caused by a ruptured aneurysm was identified with malfunction of the LP shunt system by dementia and gait disturbance. Hydrocephalus was revealed on computed tomography (CT). Under a laparoscopy, the intraabdominal peritoneal catheter was observed to be obstructed by fibrous encapsulation covering it like a long white stocking. Although the fibrous encapsulating tissue was excised by laparoscopy forceps, a ventriculoperitoneal shunt device was replaced with a new peritoneal catheter. The histopathological diagnosis of the surgically resected encapsulating tissue was the fibrous tissue with a few inflammation cells and a layer of lining cells surrounding some part of it. In the immunohistochemical study, a layer of lining cells surrounding the fibrous tissue showed immunohistochemically positive staining for calretinin.
Conclusion:The fibrous encapsulation would be formed by peritoneal reaction to a peritoneal catheter as a foreign body by these histopathological and immunohistochemical analyses.
Keywords: Calretinin, fibrous encapsulation, laparoscopy, peritoneal catheter, peritoneal shunt, shunt malfunction
Peritoneal shunt has been a standard procedure to treat hydrocephalus. Unusual peritoneal complications can occur, including an abdominal cyst or a pseudocyst that usually causes signs and symptoms of intraabdominal abnormalities, especially in babies or infants.[
A 69-year-old woman had undergone lumboperitoneal shunt (LP) shunt for hydrocephalus caused by subarachnoid hemorrhage on January 14, 2016. During the LP shunt procedure, laparoscopic placement of the peritoneal catheter (Peritoneal Catheter with BioGlide®, Standard, Barium Stripe, Open Ended with 8 Wall Slits, 90 cm; Medtronic, Inc. Minneapolis, USA) into the peritoneal cavity was performed. Following LP shunt, symptoms caused by hydrocephalus in the patient disappeared. Three months later, she presented with dementia and gait disturbance in April, 2016. Hydrocephalus was diagnosed by computed tomography (CT) [
(a) The distal side of the peritoneal catheter is obstructed by a fibrous encapsulating tissue covering it like a long stocking. (b) The fibrous encapsulation covers the intraabdominal peritoneal catheter from the middle part of it to the distal side of it. (c) The fibrous encapsulating tissue disconnects with a fibrous tissue at the orifice of peritoneal cavity. (d) The fibrous encapsulating tissue is about 16cm long and it looks like a long white stocking
(a) Photomicrograph of the surgical specimen shows fibrous tissue with a few inflammatory cells. And it is covered with a layer of cells suspected to be mesothelium cells (and ←). Hematoxylin and eosin stain, original magnification ×200. (b) Immunohistochemical examination revealing that a layer of cells suspected to be mesothelium shows positive staining for calretinin in the current case. Immunohistochemical examination revealing that a layer of lining cells (c) and a few surface cells (and ↑) (d) also show positive staining for calretinin in previously reported fibrous capsule cases
Fibrous capsule formation of the end of a peritoneal catheter, which covered it like a stocking was first described in 1954 [
A fibrous encapsulation or capsule covering the peritoneal catheter like a long stocking or sox obstructed a peritoneal catheter and caused hydrocephalus without signs and symptoms of intraabdominal abnormalities. On the other hand, the obstruction of distal catheter tip ensheathed by adhesions and scar tissue also caused hydrocephalus without abdominal complications.[
An abdominal cyst or a pseudocyst as an unusual peritoneal shunt complication usually has signs and symptoms of intraabdominal abnormalities in babies or infants.[
The histopathological feature of the fibrous encapsulating tissue in the current case is a fibrous tissue with a few inflammatory cells, and some part of it are covered with a layer of lining cells supposed to be mesothelium cells [
Interestingly, fibrous tissue at the orifice of the peritoneal cavity does not connect with fibrous encapsulating tissue [
The encapsulation of this current case was formed for only 3 months following LP shunt. One of the previously reported fibrous capsules was also formed for 5 months following VP shunt [
Occlusion of the peritoneal catheter tip was reported to appear in 9.5% of the cases among abdominal complications in VP shunt, even though CSF loculation or cyst formation appeared in 1.7%.[
In conclusion, the fibrous encapsulation or capsule would be formed by peritoneal reaction to the peritoneal catheter as a foreign material according to the histopathological and immunohistochemical analyses. The fibrous encapsulating tissue would turn into a fibrous capsule. Laparoscopy can offer several advantages in placement or observation of a peritoneal catheter into peritoneal cavity.[
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