脳室腹腔短絡術の稀な腹腔内合併症—3例報告

Rare Intra-abdominal Complications of a Ventriculoperitoneal Shunt : report of three cases

I．はじめに

　脳室腹腔髄液シャント術（ventriculoperitonealCSF shunt：以下VPS）は水頭症に対して最も一般的なシャント術式である．当施設のVPS施行例のうち，その後シャントシステムの再建術や抜去術を施行した例を検討したところ，シャントシステムの機械的な閉塞や屈曲による通過障害と感染症が最も多い合併症であったが，本稿ではこれらのうち稀と思われる腹腔内髄液偽嚢胞の形成，横隔膜下膿瘍の形成，腹腔側チユーブの直腸壁への穿孔（肛門部より脱出）の3例について報告する．

Three cases of rare intra-abdominal complications of ventriculoperitoneal shunt (VPS) surgery are re-ported. Case 1 was a 32-year-old male who had undergone VPS surgery for hydrocephalus following meningitis on July 10, 1980. Two weeks later he developed fever and a cystic mass about 10cm in diameter in the right hypochondrium. Shuntography and a barium enema study demonstrated a pseudocyst at the distal end of the shunt. The cyst wall was excised, the peritoneal tube removed, and VPS converted to a ventriculoatrial route following which the pseudocyst resolved. Case 2 was a 49-year-old female who de-veloped hydrocephalus following subarachnoid hemorrhage, and VPS surgery was performed on March 10, 1989. Two weeks later, she developed fever and right upper abdominal pain. Abdominal x-ray and CT scan revealed a right subdiaphragmatic abscess. The abscess was drained and the shunt system was re-moved on April 4. VPS was placed again on April 21 without further complications. She was symptom free for the next 7 years. Case 3 was a 57-year-old female who presented in a semicomatous state after fall-ing from bed on May 5, 1995. CT scan showed left-sided acute subdural hematoma (ASDH) for which sur-gery was performed. Her neurological status improved postoperatlvely. She eventually developed hydroce-phalus and left-sided subdural effusion for which right VPS and left subduroperitoneal shunt (SPS) sur-gery was performed on January 25, 1996. The peritoneal end of the tube of the SPS protruded out of the anus one and a half year after shunt piacement, The entire SPS system was removed as there was no more collection in the subdural space.

We reviewed the literature and discussed the pathophysiology involved in the development of intra-abdominal complications following VPS.