Kin S, Imamura J, Ikeyama Y, Jimi Y, Yasuhara S
Department of Neurosurgery, National Shimonoseki Hospital.
No Shinkei Geka. 1997 Jun;25(6):573-5.
A case is reported of intestinal perforation by a ventriculoperitoneal shunt (V-P shunt) tube 10 years after V-P shunt. A 49-year-old male received V-P shunt for normal pressure hydrocephalus following subarachnoid hemorrhage. Ten years later he was admitted to our department with an abscess on the anterior chest and on the abdominal wall along the shunt tube. When CT scan revealed that the peritoneal tube had perforated the bowel, the shunt was removed. During the operation it was found that the peritoneal tube was wrapped with fibrous tissue and that it had perforated the intestine. The subcutaneous abscess healed after the patient received systemic antibiotics. He was discharged and returned to work. We discussed the mechanism of bowel perforation in this case. It is assumed that bowel perforation occurred because of continuous friction at the same site of the bowel wall after the peritoneal tube received fibrous encasement in the abdominal cavity. Bowel perforation was diagnosed ten years after the V-P shunt in this case. To our knowledge, this is the longest period amongst reported cases.
本文报告一例脑室腹腔分流术（V-P分流术）10年后发生肠穿孔的病例。一名49岁男性在蛛网膜下腔出血后因正常压力脑积水接受了V-P分流术。10年后，他因前胸及沿分流管腹壁出现脓肿入住我科。CT扫描显示腹腔分流管已穿破肠管，遂将分流管取出。手术中发现腹腔分流管被纤维组织包裹，并已穿破肠管。患者接受全身抗生素治疗后，皮下脓肿愈合。患者出院并恢复工作。我们讨论了该病例肠穿孔的机制。推测腹腔分流管在腹腔内被纤维包裹后，在肠壁同一部位持续摩擦导致肠穿孔。该病例在V-P分流术后10年才诊断出肠穿孔。据我们所知，这是报告病例中间隔时间最长的。
