China
Africa
Explore chapters and articles related to this topic
Sacrococcygeal teratoma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Agostino Pierro, Miguel Guelfland, Annika Mutanen
There may be large vessels or ulcers visible on the tumor surface. In all cases, the tumor is attached to the coccyx (therefore the necessity of coccygectomy during tumor excision) and projects to a varying degree into the presacral space between the sacrum and the rectum. In most cases, the blood supply to the tumor is derived from the middle sacral artery. Although most neonates with SCT are asymptomatic, this upward extension into the pelvic space may compress and elevate the rectum, vagina, bladder, and uterus, causing symptoms of constipation, large bowel obstruction, urinary retention, an abdominal mass, or symptoms of malignancy, such as failure to thrive.
The Governor Vessel (GV)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Clinical Relevance: Coccydynia has several causes; one may stem from neuropathic pain mediated by the coccygeal plexus. Trigger point pathology in the ischiococcygeus muscle may compress the coccygeal plexus and exacerbate coccydynia. Coccydynia frequently worsens with sitting, standing, and even walking. Etiologies include instability of the sacrococcygeal or intercoccygeal joints and/or entrapment neuropathy or traumatic irritation of the coccygeal plexus. While coccygectomy may prove curative, treatment with acupuncture and related techniques as conservative measures should ideally be tried before surgery.
Pre-Sacral Tumours
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Epidermoid and dermoid cysts are more common in females and may be associated with a post-anal dimple or sinus. These may present as a presacral abscess when they become infected. Tailgut cysts, also referred to as cystic hamartomas, are believed to originate from remnants of the embryonic primitive gut.18 Historically, the estimated risk of malignancy of these tumours was 2% based on a multi-institutional review.18 A report from Mayo Clinic, however, reviewed 31 patients with tailgut cyst who underwent complete excision and found malignancy in 13% of patients. This series demonstrated that complete excision could usually be completed via a posterior approach, coccygectomy was not routinely required and recurrence was low (approximately 6% in those patients followed for greater than one year).19 This high number of malignant cases had not been previously reported and should raise concern when evaluating patients with cystic lesions. Whilst the majority of tailgut cysts are benign, the presence of calcification or heterogeneity within a portion of the cyst may be a sign of malignant degeneration. This series did not demonstrate that age, tumour size, duration of symptoms or the presence of a sacral mass on digital examination were predictive of malignant degeneration. As with many presacral tumours, these can reach considerable size prior to becoming symptomatic and have rarely extended out of the presacral space, posterior to the sacrum (see Figure 45.5). Whether coccygectomy needs to be performed when operating on patients with tailgut cysts is controversial.7 Coccygectomy may improve surgical exposure, and some believe that risk of recurrence is decreased after coccygectomy. However, there is limited evidence for this. In our series, only seven of 31 patients required coccygectomy and one patient required distal sacrectomy.19 Our practice is to preserve the coccyx unless resection is necessary secondary to malignancy or the cyst is densely adherent to the coccyx.
Tailgut cyst: report of three cases and review of the literature
Published in Acta Chirurgica Belgica, 2019
Ann-Sophie Hufkens, Peter Cools, Paul Leyman
Multiple surgical approaches have been described. The preferred approach primarily depends on the morphology, localization, size of the retrorectal lesion, the relationship with adjacent structures and whether there is evidence of malignancy [8,10]. The classical treatment consists of three different approaches: the anterior (transabdominal), the posterior approaches (intersphincteric, transsphincteric, parasacrococcygeal, transsacral, transsacrococcygeal, transanorectal and transvaginal) or a combination of both. If the rectal mass is situated below the level of S3 or the sacral promontory, a posterior approach is the treatment of choice [2]. In some cases a coccygectomy is performed in order to improve surgical exposure and to eliminate the possibility of recurrence [4]. The anterior approach should be reserved for relatively high lesions (above S3 or the sacral promontory) [11]. In cases with suspected malignancy a transabdominal approach is preferred because of better visualization of important structures, followed by a more complete oncological resection [4]. Recently a new surgical approach using transanal minimally invasive surgery (TAMIS) is described in the literature. This new approach shows similar outcomes with the advantage of being less invasive [10,11]. A transanal or transrectal approach is indicated for small low-lying, non-infected cases because a higher risk of pelvic infection is described using the rectum as a portal of entry [4].
Influence of psychiatric disorders and chronic pain on the surgical outcome in the patient with chronic coccydynia: a single institution’s experience
Published in Neurological Research, 2020
Kristopher A. Lyon, Jason H. Huang, David Garrett
Coccygectomy, the surgical resection of one or more coccygeal vertebrae, has been performed for hundreds of years with varying levels of success. The first recorded coccygectomy was performed in 1726 for probable tubercular invasion of the tailbone, while in 1840, Blundell performed the first coccygectomy for pain relief [1]. About a decade later, Simpson created a new term, ‘coccygodynia’ – later shortened to ‘coccydynia,’ to specifically describe pain in the tailbone region [2]. To determine why pain may arise from the coccyx, it is important to understand the interaction of the coccyx with its surrounding anatomy.