術後長期間を経て脳室腹腔シャントチューブが胸腔内へ迷入した1例

Migration of the Distal Catheter of Ventriculo-Peritoneal Shunt into the Thoracic Cavity

Ⅰ．はじめに

　水頭症に対する脳室腹腔短絡術（ventriculo-peritoneal shunt：VPS） は一般的な治療法である．シャントチューブが異所に迷入することは稀ではあるが，その報告は散見される．本稿では，VPS術後長期間を経て腹側シャントチューブが胸腔内に迷入し，無症候性の胸水貯留を来したが自然寛解した1例を報告し，迷入の機序について考察を加える．

　A 69-year-old woman suffered from ataxia of her right upper and lower limbs and infection in a distal tube of a ventriculo-peritoneal shunt (VPS). She had a thirty-year history of treatment for intracranial hemangioblastoma due to von Hippel-Lindau disease and hydrocephalus. Head magnetic resonance imaging demonstrated recurrent multiple hemangioblastoma in the cerebellum without hydrocephalus. Chest computed tomography showed a migrated distal tube of a VPS into the thoracic cavity. The VPS had been revised several times because of repeated infection before the present admission. The hydrocephalus was considered to be independent on the VPS because the VPS had become obstructed. A pleural effusion,which was probably caused by hypoalbuminemia during the postoperative course of the hemangioblastoma,increased and disappeared in association with her postoperative nutritional status. Therefore,revision of the migrated distal catheter was not needed. The distal tube most likely migrated through the intercostal space because the patient was very skinny.

　Migration of the distal catheter of VPS into the thoracic cavity may occur when the course of the distal tube is close to the thoracic cavity,especially in thin patients. Care should be taken when routing the distal catheter after VPS in skinny patients.