Neurological Surgery 脳神経外科33巻7号

2005年07月発行

症例

脳室腹腔シャント術後に生じたspontaneous umbilical fistulaの1例

著者： 高瀬卓志¹ 多根一之¹ 鈴木俊久¹ 井上剛¹ 麓佳良¹

所属機関： ¹多根総合病院脳神経外科

ページ範囲：P.725 - P.729

Ⅰ．はじめに

　水頭症に対する脳室腹腔シャント術は確立された治療手技であるが，術後に種々の腹部合併症が起こり得ることは周知の事実であり，感染やカテーテル閉塞の他に報告例として，fibrous encasement of the peritoneal catheter²⁾，postoperative ileus⁵⁾，volvulus⁸⁾などがある．さらに髄液の腹腔外漏出を伴う合併症としては，extrusion of the tube through the incision²⁾，perforation of the bowel¹³⁾，extrusion of the peritoneal catheter into the scrotum⁷⁾などが報告されている．今回，非常に稀と思われる，spontaneous umbilical fistulaの1例を経験したので報告する．

参考文献

1）Adeloye A：Spontaneous extrusion of the abdominal tube through the umbilicus complicating peritoneal shunt for hydrocephalus. Case report. J Neurosurg 38：758-760, 1973

2）Ames RH：Ventriculo-peritoneal shunts in the management of hydrocephalus. J Neurosurg 27：525-529, 1967

3）Antunes AC, Ribeiro TR：Spontaneous umbilical fistula from ventriculoperitoneal shunt drainage. Report of two cases. J Neurosurg 43：481-482, 1975

4）Das PC, Radhakrishna K, Rao PL：Spontaneous umbilical fistula：A rare complication of ventriculoperitoneal shunt. J Pediatr Surg 28：630-631, 1993

5）Murtagh F, Lehman R：Peritoneal shunts in the management of hydrocephalus. JAMA 202：1010-1014, 1967

6）Pompili A, Cianfriglia F：Umbilical fistula as a complication of ventriculo-peritoneal shunt. Surg Neurol 12：129-130, 1979

7）Ramani PS：Extrusion of abdominal catheter of ventriculoperitoneal shunt into the scrotum. Case report. J Neurosurg 40：772-773, 1974

8）Sakoda TH, Maxwell JA, Brackett CE Jr：Intestinal volvulus secondary to a ventriculoperitoneal shunt. Case report. J Neurosurg 35：95-96, 1971

9）Schubert GE, Pavkovic MB, Bethke Bedurftig BA：Tubular urachal remnants in adult bladders. J Urol 127：40-42, 1982

10）Silav G, Tun K, Dolgun H, Unlu A, Selcuki M：The spontaneous umbilical perforation of the distal end of ventriculoperitoneal shunt. Neurochirurgie 48：128-130, 2002

11）Ueno T, Hashimoto H, Yokoyama H, Ito M, Kouda K, Kanamaru H：Urachal anomalies：Ultrasonography and management. J Pediatr Surg 38：1203-1207, 2003

12）Wani AA, Ramzan A, Wani MA：Protrusion of a peritoneal catheter through the umblicus：An unusual complication of a ventriculoperitoneal shunt. Pediatr Surg Int 18：171-172, 2002

13）Wilson CB, Bertan V：Perforation of the bowel complicating peritoneal shunt for hydrocephalus. Report of two cases. Am Surg 32：601-603, 1966