穿刺排膿術にともない被膜から著明な出血をきたした脳膿瘍の1例

Aspiration and Drainage for Brain Abscess Causing Massive Bleeding from Abscess Capsule:Case report

I．はじめに

　先進国における脳膿瘍は最早まれな疾患となり，近年では死亡率は激減しているが，著しいmass effectを有する重症例では外科的治療が必要である．手術としては穿刺排膿術が安全で有用であり，広く行われているが，今回われわれは，穿刺術にともなったまれな合併症を経験したので報告する．

The authors report a rare complication during aspira-tion of a brain abscess.

A 23 year-old man who had undergone surgery for empyema two months previously presented himself at our hospital complaining of headache, deterioration of activity and conscious level. An emergency computed tomography demonstrated a left frontal brain abscess. Aspiration and drainage were performed. However, this resulted in massive hematoma in and around the abs-cess capsule. Following craniotomy and excision of the abscess, the patient was cured. Microscopic examina-tion of the abscess revealed the formation of a com-plete capsule consisting of fibroblasts and collagen fi-ber. In addition to this, significant neovascularization with inflammatory cells was apparent around the cap-sule. These findings suggest that profuse hemorrhage may occur in aspiration and drainage surgery.