V-Pシャント術10年を経て腹腔管が膀胱を穿通し髄膜炎を来たした1例

Perforation of the Bladder by a Peritoneal Catheter : an unusual late complication of ventriculo-peritoneal shunt

I．はじめに

　脳室腹腔短絡術は脳外科手術のうちでも手術機会の多いものである．しかし，その手術手技の容易さの割に比較的多くのトラブルを来たすことがしられている．そのなかでも手術から数年が経過し，完治と判断された後に起こってくる合併症は，発見の遅れることもあり十分な注意が必要と思われる．

　今回われわれは，手術後10年を経て腹腔管が尿道口より露出し，髄膜炎を来たした症例を経験したため報告する．

Late perforation of the bladder by an abdominal catheter of a ventriculoperitoneal (VP) shunt is ex-tremely rare. We report the successful treatment of a patient who presented with this complication. An 82-year-old woman received a V-P shunt for normal pressure hydrocephalus following subarachnoid hemor-rhage. Ten years later she was admitted to our hospital with neck pain. A few days after admission, the tipof the peritoneal catheter was found to be protruding from the urethra during urination. Subsequently, thepatient developed meningitis. Contrast study of the distal tubing demonstrated the continuity of the peri-toneal shunt tube. After the entire system was removed, antibiotic treatment was administered for 2 weeks,and a new VP shunt was placed on the opposite side. The post-operative course was uneventful.

Previous reports regarding complications after the placement of a VP-shunt show that periodic chest andabdominal X-ray studies are important. In this case, however, the peritoneal tube was not able to beobserved on abdominal plain film. For this reason, an unfaded radiopaque tube is necessary if there is to beearly diagnosis of late organic perforation by a peritoneal shunt tube.