脳室腹腔シャントチューブが横行結腸内へ迷入した1例

Ventriculo-peritoneal shunt penetrating into transverse colon : A case report

◆要旨：症例は51歳の女性である．既往歴として，48歳時に左視床出血に伴う水頭症に対し脳室腹腔シャント（以後，VPS）を造設している．発熱の精査のため，腹部造影CTを施行したところ，VPSが横行結腸内へと迷入している所見を認めた．腹部に圧痛はなく，腹膜刺激徴候も認めなかった．発熱の原因は，VPSを介する逆行性感染による髄膜炎と考えられた．腹腔鏡下にて，VPSの抜去と瘻孔結紮を行った．術後は髄膜炎に対し抗菌薬投与を行った．VPSの消化管穿通は稀に認める合併症であり，逆行性感染による髄膜炎が起こる．治療法はVPSの抜去と抗菌薬治療である．抜去において，低侵襲に適切な処置が行える点から，腹腔鏡下手術は有用であると考えられた．

　The patient was a 51-year-old woman who had undergone ventriculo-peritoneal shunt （VPS） surgery for hydrocephalus due to thalamic hemorrhage 3 years previously. Her chief complaint was fever; thus, abdominal CT was performed, which showed that the VPS had penetrated the transverse colon. She had no abdominal pain or sign of peritoneal irritation. It was therefore considered that her fever was caused by meningitis from retrograde infection via the VPS. Laparoscopic surgery was performed. The VPS was found to have penetrated the transverse colon. Moreover, it was covered by fibrous tissues, creating a fistula. We removed the peritoneal shunt tube and performed ligation of the fistula laparoscopically. After surgery, antibiotics were administered for meningitis. We then placed a ventricular drainage tube postoperatively to manage hydrocephalus. After these treatments, her condition gradually improved, and the patient was discharged from our hospital 58 days after the removal of the VPS. Bowel penetration by peritoneal shunt tube in patient with VPS is rare. As a minimally invasive therapy, laparoscopic surgery was useful for treatment of penetration of the VPS into the transverse colon.