Stomach Perforation Induced by a Migrating Ventriculoperitoneal Shunt

游移之腦室腹膜引流管導致之胃穿孔：病例報告

譚家偉(Ka-Wai Tam) ； 梁宏華(Hung-Hua Liang) ； 陳煥杰(Huan-Chieh Chen) ； 甘宜弘(I-Hung Kan)陳守誠(Soul-Chin Chen)

《輔仁醫學期刊》 6卷4期 (2008/12) Pp. 185-190

摘要

背景和目的：腦室腹膜引流管用於腦積水之患者，有各樣的併發症曾被報告過，但是對腸胃道造成的併發症並不多見。治療時常需要剖腹探查。個案報告：一名86歲男性至急診求助，表現為急性上消化道出血及腹膜炎。過去病史為創傷性腦積水而有腦室腹膜引流管之留置。在胃鏡檢查後，發現為腦室腹膜引流管導致之胃穿孔。患者在腹腔鏡探查手術後，成功移除腦室腹膜引流管並修補胃穿孔。討論：謹慎挑選患者的前提下，潰瘍穿孔以腹腔鏡探查，可以成功的完成微創手術治療，並移除腹膜腔異物，在我們的經驗中，有良好的治療成果。

關鍵字

腦室腹膜引流管 ； 胃穿孔

並列摘要

We describe an unusual presentation of stomach perforation induced by a migrating ventriculoperitoneal (VP) shunt. An 86-year-old man suffered a head injury with traumatic intracranial and subdural hemorrhage, and had received a craniotomy 1 year previously. A VP shunt was inserted 8 months previously because of hydrocephalus. He came to our emergency department because of nausea, vomiting, and abdominal tenderness. A coffee-ground substance was noted in his vomitus. Gastroscopy revealed a stomach perforation induced by a migrating VP shunt. Placement of a VP shunt is the most common treatment for hydrocephalus. The procedure is associated with various complications, 25% of which are abdominal. Bowel perforation by a VP shunt is rare with an overall frequency of 0.01%~0.07%. In our experience, laparoscopic repair of a stomach perforation induced by a migrating VP shunt is a suitable and minimally invasive procedure. The patient was successfully treated with laparoscopic surgery. After the operation, the patient had no symptoms of stomach perforation or bleeding, and was free of signs of increasing intracranial pressure.

並列關鍵字

ventriculoperitoneal shunt ； stomach perforation