Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
World Neurosurg. 2020 Sep;141:131-136. doi: 10.1016/j.wneu.2020.05.169. Epub 2020 May 24.
Ventriculoperitoneal shunt placement is a common standard treatment for hydrocephalus, and these shunts function appropriately in the presence of a pressure gradient between the ventricular and abdominal cavities.
We encountered 2 cases of shunt malfunction that was due to an increase in intra-abdominal pressure, mainly caused by constipation and excessive accumulation of enteric gas. Although aggressive bowel regimens were implemented, this management failed in both patients. Careful physical examination revealed unusually elevated tonus of the anus sphincter muscle, and a fecal incontinence catheter was inserted into the rectum. Following this procedure, constipation rapidly improved together with a marked reduction in enteric gas, leading to a normalization of ventricular size on imaging and neurologic improvements. Both patients were able to avoid unnecessary surgical exploration or shunt revision.
Constipation is one of the differential diagnoses of ventriculoperitoneal shunt malfunction, and bowel regimens are the first-line treatment. However, some cases can prove resistant to medical therapy, and mechanical tube placement can provide an alternative or additional solution. Before proceeding to surgical exploration, the intra-abdominal environment should be properly assessed and every option should be explored to address underlying causes of shunt failure to avoid unnecessary intervention.
脑室腹腔分流术是脑积水的一种常见标准治疗方法，这些分流器在脑室和腹腔之间存在压力梯度的情况下能正常工作。
我们遇到了 2 例因腹内压升高而导致分流器故障的病例，主要是由便秘和肠内气体过度积聚引起的。尽管实施了积极的肠道治疗方案，但这两种方法在这两名患者中均失败。仔细的体格检查发现肛门括约肌的张力异常升高，并向直肠插入了粪便失禁导管。此后，便秘迅速改善，肠内气体明显减少，导致脑室大小在影像学上恢复正常，神经功能也得到改善。两名患者均避免了不必要的手术探查或分流器修订。
便秘是脑室腹腔分流器故障的鉴别诊断之一，肠道治疗方案是一线治疗方法。然而，有些病例可能对药物治疗有抗性，机械管的放置可以提供另一种或额外的解决方案。在进行手术探查之前，应适当评估腹内环境，并应探讨所有选择，以解决分流器故障的根本原因，避免不必要的干预。
