Brownlee J D, Brodkey J S, Schaefer I K
Department of Surgery, Columbia Saint Luke's Medical Center, Cleveland, OH 44104, USA.
Surg Neurol. 1998 Jan;49(1):21-4. doi: 10.1016/s0090-3019(97)00014-1.
A case of colonic perforation by a ventriculoperitoneal shunt is presented in a patient with several previous complications associated with shunt tubing.
Initially managed by intravenous antibiotics, shunt externalization, and colonoscopy, the entire ventriculoperitoneal shunt system was subsequently replaced after cerebrospinal fluid cultures had grown Propionibacterium acnes and Streptococcus sanguis organisms. The patient has had three episodes of skin breakdown over his shunt tubing (two prior and one subsequent to colonic perforation) without evidence of shunt infection or malfunction.
The etiology of these complications is consistent with silicone tubing allergy. Replacement with a polyurethane system produced no similar complications thus far, which further supports a possible silicone allergy to the ventriculoperitoneal shunt and possible etiology of this patient's colonic perforation.
本文报告一例脑室腹腔分流管导致结肠穿孔的病例，该患者既往有多种与分流管相关的并发症。
最初采用静脉抗生素、分流管外置和结肠镜检查进行处理，随后在脑脊液培养出痤疮丙酸杆菌和血链球菌后，更换了整个脑室腹腔分流系统。该患者在分流管部位出现过三次皮肤破损（两次在结肠穿孔之前，一次在结肠穿孔之后），但无分流管感染或故障迹象。
这些并发症的病因与硅胶管过敏一致。迄今为止，更换为聚氨酯系统未产生类似并发症，这进一步支持了脑室腹腔分流管可能存在硅胶过敏以及该患者结肠穿孔可能的病因。
