脳室腹腔シャント術後に生じたspontaneous umbilical fistulaの1例

Spontaneous Umbilical Fistula as a Complication of Ventriculo-peritoneal Shunt ： Case Report

Ⅰ．はじめに

　水頭症に対する脳室腹腔シャント術は確立された治療手技であるが，術後に種々の腹部合併症が起こり得ることは周知の事実であり，感染やカテーテル閉塞の他に報告例として，fibrous encasement of the peritoneal catheter²⁾，postoperative ileus⁵⁾，volvulus⁸⁾などがある．さらに髄液の腹腔外漏出を伴う合併症としては，extrusion of the tube through the incision²⁾，perforation of the bowel¹³⁾，extrusion of the peritoneal catheter into the scrotum⁷⁾などが報告されている．今回，非常に稀と思われる，spontaneous umbilical fistulaの1例を経験したので報告する．

We report a rare case of a spontaneous umbilical fistula as a complication of ventriculo-peritoneal shunt. A 36 year-old male was admitted our hospital complaining serous discharge from the umbilicus. Two years before admission,he underwent ventriculo-peritoneal shunt for the hydrocephalus due to right hypertensive intracranial hematoma and intraventricular hemorrhage. A shuntgraphy was done and it revealed the cerebrospinal fluid leakage from the umbilicus through an urachal remnant. The abdominal shunt tube was removed at the surgery,and the patient was discharged uneventfully without shunt revision. The possible etiology of this rare complication in this case was supposed to be due to the persistence of the urachus.