腰椎-腹腔シャントの腹腔カテーテルが横隔膜下に迷入し難治性吃逆を来した1例

Recurrent Hiccups Caused by Malposition of the Peritoneal Catheter of a Lumboperitoneal Shunt:A Case Report

Ⅰ．はじめに

　脳室-腹腔（ventriculoperitoneal：VP）シャントや腰椎-腹腔（lumboperitoneal：LP）シャントによるさまざまな腹部の合併症が過去に報告されている^{1-8,10,13,15-22)}．われわれはLPシャントの腹腔カテーテルが横隔膜下に迷入し難治性吃逆を来したため，腹腔カテーテルを横隔膜下から引き抜き難治性吃逆の消失が得られた稀な1例を経験したので，文献的考察を加え報告する．

　A number of rare and unpredictable shunt-related complications after shunt placement to treat hydrocephalus have been described. Here a 78-year-old man who underwent lumboperitoneal（LP）shunt placement presented postoperatively with recurrent hiccups. Abdominal radiography and computed tomography performed at 7 days postoperative revealed that a peritoneal catheter had migrated into the upper abdominal cavity and contacted the diaphragm. The patient underwent LP shunt revision, during which the catheter was pulled back and repositioned within the lower abdominal cavity. The hiccups ceased completely. To our knowledge, the only other report of a similar complication was published in the 1980s. Here we describe a case in which a peritoneal catheter from an LP shunt migrated into the upper abdominal cavity and irritated the diaphragm, causing recurrent hiccups.