穿刺排膿後遅発性に被膜より出血を来したガス産生脳膿瘍の1例

Aspiration and Drainage for a Gas-Producing Brain Abscess Causing Delayed Bleeding from the Abscess Capsule : A Case Report

I．はじめに

　近年脳膿瘍の外科的治療において，定位的穿刺排膿術は低侵襲で合併症の少ない術式として広く普及し，施行される機会も増えているが，実際に合併症を来した報告例は少なく，穿刺にて被膜より大出血を来した例^5）などが散見されるに過ぎない．今回われわれは，ガス産生菌による脳膿瘍に対して定位的穿刺排膿術を施行して膿瘍を縮小させたが，2週間後に膿瘍が急激に再増大してきたため，再度穿刺排膿術を施行したところ，黒色の凝血しない陳旧性血腫の流出を認めた．初回術中，術直後に出血は来しておらず，穿刺した被膜から出血が遅発性に起こり，凝血しない血液が徐々に貯留してきたものと思われた．脳膿瘍の定位的穿刺排膿術後にこのような合併症を来した報告例は過去に確認し得ず，若干の文献的考察を加え報告する．

A 65-year-old man was admitted with the complaint of gait disturbance. CT scan revealed a low density lesion in the right parietal lobe. MRI was carried out 3 days after admission, the lesion showing low in- tensity on T1 WI and T2 WI. Gd-DTPA enhanced T1 WI showing abnormal enhancement surround it. CT scan then revealed a gas bubble in the lesion 12 days after admision, so we diagnosed it as gas-producing brain abscess and aspiration, drainage and irrigation with antibiotics were performed. Although, the brain abscess was reduced in size after the operation, the lesion expanded again 2 weeks after the operation.MRI was performed and the lesion showediso-intensity on T1 WI and high intensity on T2 WI.Emergentaspiration and drainage were performed anduncoagulated old-hematoma-like matter such aschronic sub-dural hematoma was removed. As significantneovascularization with inflammatory cells had beendetectedin the capsule of the brain abscess, we suspectedthat aspiration and drainage surgery for brainabscessmay cause delayed bleeding from the capsule of theabscess. We conclude that attention should be drawnto such a complication.