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Cureus Jan 2021Erector spinae plane block (ESPB) is a new and popular interfacial fascial plane block which has been used in many different surgeries. There are a few cases in which...
Erector spinae plane block (ESPB) is a new and popular interfacial fascial plane block which has been used in many different surgeries. There are a few cases in which ultrasound-guided sacral ESPB was used for postoperative analgesia. This article presents the successful use of bi-level, bilateral sacral ESPB for main anesthetic method in anorectal surgery. Anesthetic level required for surgery was accomplished in 30 minutes, and none of the patients experienced pain throughout the surgery. The patients were discharged at the postoperative fourth hour without any complications. The patients, who were contacted later, indicated no need for any analgesic for 24 h postoperatively. To the best of our knowledge, this is the first case report in the literature where sacral ESPB is used as the sole anesthetic technique. The sacral ESPB can be considered in anorectal surgery as an alternative technique for spinal or general anesthesia.
PubMed: 33585088
DOI: 10.7759/cureus.12598 -
Neurosurgery Nov 2010We present a rare case of a rectothecal fistula arising from an anterior sacral meningocele in a patient with Currarino syndrome.
BACKGROUND AND IMPORTANCE
We present a rare case of a rectothecal fistula arising from an anterior sacral meningocele in a patient with Currarino syndrome.
CLINICAL PRESENTATION
The patient was a 40-year-old woman presenting with cauda equina syndrome and ascending meningitis. The meningocele was removed using an anterior abdominal approach. A sigmoid resection was performed with rectal on-table antegrade lavage followed by closure of the rectal fistula, closure of the rectal stump, and proximal colostomy. Closure of the sacral deficit was carried out by suturing a strip of well-vascularized omentum and fibrin glue.
CONCLUSION
We discuss the characteristics, management, and evolution of this unusual case. Prompt surgical management using an anterior approach, resection of the sac, closure of the sacral deficit, and fecal diversion resulted in a satisfactory outcome.
Topics: Female; Humans; Meningocele; Middle Aged; Polyradiculopathy; Rectal Fistula; Rectum; Sacrum; Treatment Outcome
PubMed: 20871432
DOI: 10.1227/NEU.0b013e3181f352ba -
Pediatric Surgery International Aug 2014The presence of esophageal atresia (EA) in patients with an anorectal malformation (ARM) is well known. The purpose of this work is to find out the most common type of... (Review)
Review
PURPOSE
The presence of esophageal atresia (EA) in patients with an anorectal malformation (ARM) is well known. The purpose of this work is to find out the most common type of ARM associated to EA and the functional prognostic implication of this association, which has not been described in previous publications.
METHODS
We reviewed our database for demographic, functional, and associated anomalies data in our patients with EA and ARM, and then compared them with those of our general series of ARM without esophageal atresia.
RESULTS
Out of 1,995 ARM patients, 167 had a concomitant EA (8.3 %). Prostatic fistula was the most common type of defect in the male EA patients (45.9 %) and cloacas were on the female group (57.9 %). EA patients had worse bowel (47 vs. 67 %) and urinary control (56.6 vs. 79.4 %) when compared to the general series (GS). Functional prognosis was significantly worse in cloacas and in patients subjected to re-operations (p < 0.001). EA patients had a 0.52 average sacral ratio and in the GS was 0.65 (p < 0.001). EA patients had a significantly higher incidence of tethered cord (32.3 vs. 17.6 %), cardiac anomalies (32.3 vs. 22.5 %) including VSD (12.5 vs. 4.5 %), hydronephrosis (36.5 vs. 15.4 %), absent kidney (26.3 vs. 10.5 %), duodenal atresia (7.7 vs. 1.7 %), vertebral anomalies (28.1 vs. 14 %), extremity defects (11.3 vs. 3.1 %), tracheal anomalies (6.5 vs. 0.4 %), and developmental delay (5.9 vs. 1.4 %).
CONCLUSIONS
The presence of esophageal atresia in ARM patients has a significant, probably coincidental, impact on bowel and urinary control. This association is also related with worse types of ARM defects and with more severe associated anomalies. This association should increase the awareness on the provider in terms of what to expect on functional prognosis and a throughout search for associated anomalies.
Topics: Abnormalities, Multiple; Anal Canal; Anorectal Malformations; Anus, Imperforate; Esophageal Atresia; Female; Global Health; Humans; Incidence; Male; Prevalence; Rectum
PubMed: 24993283
DOI: 10.1007/s00383-014-3531-9 -
Journal of Pediatric Surgery Aug 2016Outcomes of patients with an ARM-type rectovesical fistula are scarcely reported in medical literature. This study evaluates associated congenital anomalies and...
PURPOSE
Outcomes of patients with an ARM-type rectovesical fistula are scarcely reported in medical literature. This study evaluates associated congenital anomalies and long-term colorectal and urological outcome in this group of ARM-patients.
METHODS
A retrospective Dutch cohort study on patients treated between 1983 and 2014 was performed. Associated congenital anomalies were documented, and colorectal and urological outcome recorded at five and ten years of follow-up.
RESULTS
Eighteen patients were included, with a mean follow-up of 10.8years. Associated congenital anomalies were observed in 89% of the patients, 61% considered a VACTERL-association. Total sacral agenesis was present in 17% of our patients. At five and ten years follow-up voluntary bowel movements were described in 80% and 50%, constipation in 80% and 87%, and soiling in 42% and 63% of the patients, respectively. Bowel management was needed in 90% and one patient had a definitive colostomy. PSARP was the surgical reconstructive procedure in 83%. Urological outcome showed 14 patients (81%) to be continent. No kidney transplantations were needed.
CONCLUSION
In our national cohort of ARM-patients type rectovesical fistula that included a significant proportion of patients with major sacral anomalies, the vast majority remained reliant on bowel management to be clean after ten years follow-up, despite "modern" PSARP-repair. Continence for urine is achieved in the majority of patients, and end-stage kidney failure is rare.
Topics: Abnormalities, Multiple; Anal Canal; Anorectal Malformations; Anus, Imperforate; Child, Preschool; Colostomy; Constipation; Defecation; Esophagus; Female; Follow-Up Studies; Heart Defects, Congenital; Humans; Kidney; Limb Deformities, Congenital; Male; Netherlands; Postoperative Complications; Rectal Fistula; Retrospective Studies; Spine; Trachea; Urinary Bladder Fistula
PubMed: 26921937
DOI: 10.1016/j.jpedsurg.2016.02.002 -
Journal of Neurosurgery Apr 1992The authors report a series of seven patients with myelopathy who were found to have spinal dural arteriovenous (AV) fistulas in which the nidus was located at some... (Review)
Review
The authors report a series of seven patients with myelopathy who were found to have spinal dural arteriovenous (AV) fistulas in which the nidus was located at some distance from the spinal cord. The nidus was intracranial in three cases and involved a sacral nerve root sheath in the other four; in each case, the arterialized draining vein led into the coronal plexus of medullary veins. A lack of normal draining radicular veins was noted in all cases. Magnetic resonance images were obtained in four patients and demonstrated spinal cord tissue changes only in the lower thoracic cord in three cases and in the cervical cord in one, all consistent with an ischemic process secondary to venous hypertension. Five patients were managed surgically by division of the draining vein, with improvement of the neurological deficit in all. One patient was treated by embolization alone and had stabilization of her deficit. The remaining patient in the series died of unrelated systemic disease before the spinal dural AV fistula could be treated. These cases support the theory that venous hypertension is the dominant pathophysiological mechanism involved in spinal dural AV fistulas independent of their location. In patients with a suspected spinal dural AV fistula, lumbar and thoracic spinal angiography will reveal the site of the fistula in the majority of cases (88% in this series). In the remaining patients, the possibility of a remote fistula must be considered. The lack of normal venous drainage of the cord following injection in the artery of Adamkiewicz is the most reliable indicator of venous hypertension in the cord and can be helpful in making the decision to proceed with a search for a cranial or sacral arterial supply.
Topics: Adult; Aged; Arteriovenous Fistula; Cerebral Veins; Dura Mater; Female; Humans; Male; Middle Aged; Radiography; Sacrococcygeal Region; Spinal Cord Diseases
PubMed: 1545254
DOI: 10.3171/jns.1992.76.4.0615 -
Interventional Neuroradiology : Journal... Apr 2024Spinal angiography (SpAn) is the gold standard for diagnosis of spinal dural fistulas and arteriovenous malformations. A complete spinal angiogram necessitates the...
INTRODUCTION
Spinal angiography (SpAn) is the gold standard for diagnosis of spinal dural fistulas and arteriovenous malformations. A complete spinal angiogram necessitates the interrogation of the segmental arteries arising from the aorta at every level as well, the internal iliac; and median sacral arteries at the caudal end; and the cervical vasculature at the cranial end. SpAn has traditionally been performed with transfemoral arterial access and could be challenging. Of late, transradial arterial access has emerged as a popular alternative for endovascular surgical Neuroradiology (ESN) procedures including SpAn. However, there is paucity of the literature regarding transradial access for spinal angiography.
METHODS
After IRB approval, records and imaging were reviewed in a series of patients who underwent SpAn at our institution.
RESULTS
A total of nine spinal angiograms were performed via transradial access in a consecutive series of eight patients between July 2019 and December 2020 at our institution. Eight of these were diagnostic SpAn's, and one patient underwent SpAn with transradial approach for the treatment of a type I spinal dural arteriovenous fistula. No complications occurred during or subsequent to the procedures.
CONCLUSION
SpAn can be successfully and safely accomplished via transradial access. This approach appears to provide a stable method for interventions, as well.
Topics: Humans; Female; Male; Middle Aged; Central Nervous System Vascular Malformations; Radial Artery; Aged; Angiography; Retrospective Studies; Adult; Spinal Cord
PubMed: 36299241
DOI: 10.1177/15910199221135052 -
Plastic and Reconstructive Surgery.... Nov 2022We report the clinical course of a patient who developed a sacral radiation ulcer 19 years after treatment for cervical cancer. The patient's postoperative course after...
We report the clinical course of a patient who developed a sacral radiation ulcer 19 years after treatment for cervical cancer. The patient's postoperative course after a free latissimus dorsi muscle flap transfer was favorable, but various late radiation complications, including rectal perforation, a rectal fistula, sacral necrosis, a rectointestinal fistula, and sacroiliac joint osteomyelitis, occurred within 11 years. Plastic surgeons who treat such ulcers need to know that patients may develop other serious radiation-related complications. Being aware of these complications will allow appropriate measures to be taken and aid decisions regarding future surgical strategies. More careful assessment of sacral necrosis and bone resection may have ameliorated some of the complications. When encountering similar patients, we believe that careful magnetic resonance imagery (MRI) and intraoperative evaluation are warranted, as sacral necrosis may be detectable in some patients.
PubMed: 36438473
DOI: 10.1097/GOX.0000000000004686 -
Neuroradiology May 2012
Topics: Angiography, Digital Subtraction; Arteriovenous Fistula; Cauda Equina; Diagnosis, Differential; Embolization, Therapeutic; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neural Tube Defects; Sacrum
PubMed: 21701867
DOI: 10.1007/s00234-011-0899-2 -
Frontiers in Neurology 2018Spinal dural arteriovenous fistula (SDAVF) is the most common vascular malformation of the spine in adults. However, the coincidence of tethered cord syndrome, lipoma,...
Spinal dural arteriovenous fistula (SDAVF) is the most common vascular malformation of the spine in adults. However, the coincidence of tethered cord syndrome, lipoma, and SDAVF on the sacral level is exceptionally rare. We describe two patients, probably the fifth and sixth ever reported. The first was a 33 year-old female who underwent surgical cord de-tethering. Surprisingly, a sacral SDAVF was discovered intraoperatively, despite negative digital subtraction angiography (DSA). The second patient was a 30 year-old male with similar pathologies. After three failed embolizations, the fistula was surgically disconnected. Both patients recovered well. A review of patients with sacral SDAVF coexisting with spinal dysraphism, with an emphasis on the basis of symptoms was done. As a rule, in these coincident disorders, the SDAVF was the direct cause of increasing symptoms. Previous reports and our findings reveal that surgery might be superior to endovascular embolization for treating sacral SDAVFs with coexisting entities, because surgery offers a one-step treatment.
PubMed: 30319536
DOI: 10.3389/fneur.2018.00807 -
Journal of Pediatric Surgery Oct 1982From October 1980 to November 1981, 34 patients with anorectal anomalies have been operated upon by a sagittal midline approach. The skin incision extends from the...
From October 1980 to November 1981, 34 patients with anorectal anomalies have been operated upon by a sagittal midline approach. The skin incision extends from the sacrum to the perineum (ventral aspect of the anal dimple). The superficial and deep layers of the external sphincter are identified by electrostimulation and split, with the coccyx, in the midline. Ileo- and pubococcygeal portions of the levator dorsally and then the striated muscle complex of the external sphinctor, pubococcygeus and the presumed puborectalis are split ventrally to the urethra. In no cases has the ventral portion of the levators been separated from the thick ventral portion of the external sphincter, hence the term "striated muscle complex." When the terminal bowel is dilated (congenitally ectatic), the bowel is tailored prior to reconstruction of the sphinctors. The posterior sagittal approach provides an excellent exposure for evaluation and mobilization of the terminal bowel. It enables one to construct an anal canal, suture the bowel wall to the striated musculature and the mucosa to the skin, thereby reducing or avoiding the complications of prolapse and stenosis. In males with ectasia and a rectourethral fistula, transrectal closure of the mucosa at the fistula site, leaving the rectal longitudinal smooth muscle insertions on the prostatic capsule, avoids damage to the nerves and genital structures.
Topics: Anal Canal; Anus, Imperforate; Child; Child, Preschool; Evaluation Studies as Topic; Female; Humans; Infant; Male; Methods; Rectum
PubMed: 7175658
DOI: 10.1016/s0022-3468(82)80126-7