Sacral plexus disorder caused by a wooden toothpick in the rectum

2021 ◽  
Vol 14 (1) ◽  
pp. e238690
Author(s):  
Takuro Endo ◽  
Taku Sugawara ◽  
Naoki Higashiyama
Keyword(s):  
Lower Limb ◽  
Spinal Nerve ◽  
Leg Pain ◽  
Sacral Plexus ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Preoperative Ct ◽  
History Of ◽  
History Of Pain ◽  
The Right

A 67-year-old man presented with a 2-month history of pain in his right buttock and lower limb. MRI depicted right L5/S1 lateral recess stenosis requiring surgical treatment; however, preoperative CT showed an approximately 7 cm long, thin, rod-shaped structure in the rectum, which was ultimately determined to be an accidentally ingested toothpick. It was removed surgically 6 days after diagnosis, because right leg pain worsened rapidly. The pain disappeared thereafter, and the symptoms have not recurred since. The pain might have been localised to the right buttock and posterior thigh in the early stages because the fine tip of the toothpick was positioned to the right of the anterior ramus of the S2 spinal nerve. Although sacral plexus disorder caused by a rectal foreign body is extremely rare, physicians should be mindful to avoid misdiagnosis.

Prompt Return to Work after Bilateral Transforaminal Full-endoscopic Lateral Recess Decompression under Local Anesthesia: A Case Report

2020 ◽  
Author(s):  
Kosuke Sugiura ◽  
Kazuta Yamashita ◽  
Hiroaki Manabe ◽  
Yoshihiro Ishihama ◽  
Fumitake Tezuka ◽  
...  
Keyword(s):  
Return To Work ◽  
Local Anesthesia ◽  
Skin Incision ◽  
Leg Pain ◽  
Lateral Recess ◽  
Canal Stenosis ◽  
Transforaminal Approach ◽  
Lateral Recess Stenosis ◽  
Lumbar Spinal ◽  
Herniated Nucleus Pulposus

AbstractTransforaminal full-endoscopic lumbar diskectomy became established early in the 21st century. It can be performed under local anesthesia and requires only an 8-mm skin incision, making it the least invasive disk surgery method available. The full-endoscopic technique has recently been used to treat lumbar spinal canal stenosis. Here, we describe the outcome of simultaneous bilateral decompression of lumbar lateral recess stenosis via a transforaminal approach under local anesthesia in a 60-year-old man. The patient presented with a complaint of bilateral leg pain that was preventing him from standing and walking, and he had been able to continue his work as a dentist by treating patients while seated. Imaging studies revealed bilateral lumbar lateral recess stenosis with central herniated nucleus pulposus at L4/5. We performed simultaneous bilateral transforaminal full-endoscopic lumbar lateral recess decompression (TE-LRD) under local anesthesia. Both decompression and diskectomy were successfully completed without complications. Five days after TE-LRD, he was able to return to work, and 3 months after the surgery, he resumed playing golf. Full-endoscopic surgery under local anesthesia can be very effective in patients who need to return to work as soon as possible after surgery.

scholarly journals Clinical Outcomes of TESSYS and TESSYS-ISEE Approach on Treatment of Lateral Recess Stenosis: A Comparison Study

2020 ◽  
Author(s):  
Boyu Wu ◽  
Chengjie Xiong ◽  
Biwang Huang ◽  
Dongdong Zhao ◽  
Zhipeng Yao ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Pain Score ◽  
Clinical Outcomes ◽  
Operation Time ◽  
The Elderly ◽  
Leg Pain ◽  
Lateral Recess ◽  
Lumbar Decompression ◽  
Lateral Recess Stenosis ◽  
Short Period

Abstract Background: Lateral recess stenosis (LRS) is a common degenerative disease in the elderly. Since the rise of comorbidity is associated with the increasing age, the percutaneous endoscopic lumbar decompression is advocated. The objective of this study was to compare the clinical outcomes of percutaneous endoscopic lumbar decompression in LRS via TESSYS or TESSYS-ISEE approach. Methods: A total of 45 and 42 consecutive patients with limp or radiculopathy symptoms underwent percutaneous endoscopic lumbar decompression using transforaminal endoscopic spine system (TESSYS) and TESSYS-ISEE, respectively. The radiation exposure and operation time, time to return to work, and complications were compared between two groups. Their clinical outcomes were evaluated with visual analogue scale (VAS) leg pain score, VAS back pain score, Oswestry Disability Index (ODI) and Modified MacNab’s criteria. Results: The average values of radiation exposure and operative time in TESSYS group were significantly higher than those in TESSYS-ISEE group (P<0.05). The postoperative VAS and ODI scores in both groups were significantly improved compared with before the operation (P<0.05). In addition, the VAS score of the leg and ODI score in the TESSYS-ISEE group were significantly lower than those in TESSYS group at 1 week follow-up (P<0.05). The good-to-excellent rates of the TESSYS and TESSYS-ISEE group were 88.89 and 90.48%, respectively, whereas the complication occurrence rates were 6.67 and 4.76% in TESSYS and TESSYS-ISEE groups, respectively. Conclusions: TESSYS-ISEE can be applied to treat LRS safely and effectively with short radiation exposure and operation time. This approach was comparable to the TESSYS approach with improved VAS leg pain and ODI score in short period after operation. However, potential complications and risks still needs to be considered.

scholarly journals Bilateral Kienböck’s disease concomitant with gouty arthritis

2020 ◽  
Vol 13 (3) ◽  
pp. e233725
Author(s):  
Deepak Chouhan ◽  
Vivek Shankar ◽  
Mohammed Tahir Ansari
Keyword(s):  
Gouty Arthritis ◽  
Left Wrist ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Daily Life Activities ◽  
History Of ◽  
Laboratory Investigations ◽  
History Of Pain ◽  
The Right ◽  
Kienbock’S Disease

A 38-year-old man presented with a 2-month history of pain and stiffness in the bilateral wrist. The pain in right wrist was disabling and severe enough to restrict the daily life activities. After the evaluation of clinical and radiological features, the patient was diagnosed with Kienböck’s disease Lichtman stage IIIB in the right wrist and stage IIIA in the left wrist. Routine laboratory investigations revealed a serum uric acid 9.27 mg/dL. Lunate excision and scaphocapitate fusion were done in the right wrist after discussing with the patient. The histopathological examinations of tophi in synovial tissue were negatively birefringent under polarised light microscopy. It confirmed the diagnoses of gout. Febuxostat was started postoperatively. The patient returned to work at the end of 5 months. There was no recurrence of symptoms and radiological signs of arthritis at the end of 1 year.

Arteries masquerading as varicose veins: A trap for phlebologists

2014 ◽  
Vol 30 (10) ◽  
pp. 729-735 ◽  
Author(s):  
L Jones ◽  
K Parsi
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Tissue Loss ◽  
Injection Sclerotherapy ◽  
Ultrasound Guided ◽  
History Of ◽  
The Right

Ultrasound guided sclerotherapy may be complicated by intra-arterial injections resulting in significant tissue necrosis. Here, we present a 69-year-old man with a history of right small saphenous vein “stripping”, presenting for the treatment of symptomatic lower limb varicose veins. Duplex ultrasound of the right lower limb outlined the pathway of venous incompetence. Despite the history of “stripping”, the small saphenous vein was present but the sapheno-popliteal junction was ligated at the level of the knee crease. No other unusual findings were reported at the time. During ultrasound guided sclerotherapy, subcutaneous vessels of the right posterior calf were noted to be pulsatile on B-mode ultrasound. Treatment was interrupted. Subsequent angiography and sonography showed absence of the right distal popliteal artery. A cluster of subcutaneous vessels of the right medial and posterior calf were found to be arterial collaterals masquerading as varicose veins. Injection sclerotherapy of these vessels would have resulted in significant tissue loss. This case highlights the importance of vigilance at the time of treatment and the invaluable role of ultrasound in guiding endovenous interventions.

Intramuscular Haemangioma of the Extensor Pollicis Brevis Muscle with Periosteal Reaction of the Radius: A Case Report and Review of the Literature

2007 ◽  
Vol 35 (5) ◽  
pp. 724-730 ◽  
Author(s):  
EH Kayias ◽  
GI Drosos ◽  
KI Kazakos ◽  
C Iatrou ◽  
KS Blatsoukas ◽  
...  
Keyword(s):  
Current Knowledge ◽  
Periosteal Reaction ◽  
Review Of The Literature ◽  
Tissue Mass ◽  
Bone Changes ◽  
History Of ◽  
Intramuscular Haemangioma ◽  
History Of Pain ◽  
The Right

We report the rare case of a histologically proven mixed-type intramuscular haemangioma, adjacent to the periosteum of the radius, that caused a periosteal reaction. We also carried out a review of the literature relevant to this case. A 28-year-old male professional drummer presented with an 8-month history of pain and swelling of the dorsal aspect of the right radius. Diagnosis was established on the basis of plain radiographs and magnetic resonance imaging, and was confirmed by histology. The lesion was treated solely by resection of the soft-tissue mass. The patient remained asymptomatic 4 years post-operatively, with no radiographic signs of recurrence. From a review of the literature, it is evident that the terminology for haemangiomas causing regional bone changes is unclear. A new classification of the intramuscular haemangiomas is proposed in order to distinguish between lesions that, according to current knowledge, exhibit radiological and clinical areas of overlap.

Microsurgical Resection of Thoracic Meningioma: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. 521-521
Author(s):  
Yutaka Ito ◽  
Kunio Yokoyama ◽  
Hidekazu Tanaka ◽  
Makoto Yamada ◽  
Masashi Yamashita ◽  
...  
Keyword(s):  
Lower Limb ◽  
Cost Effective ◽  
Magnetic Resonance Images ◽  
Surgical Removal ◽  
Spinal Meningioma ◽  
Extramedullary Tumor ◽  
Icg Angiography ◽  
History Of ◽  
The Right ◽  
Dural Opening

Abstract The primary goal of surgery with spinal meningioma is complete safe tumor removal and decompression of the spinal cord. For the surgical removal of spinal meningioma, internal debulking before dissection of the tumor capsule is essential. Intraoperative ultrasonography to localize the tumor is recommended by some authors, but we use indocyanine green (ICG) videography to visualize the localization of tumor before dural incision. ICG videography allows safe and complete delineation of intradural tumors before dural opening. This technique is quick, cost-effective, and simple to use, especially with its integration into the surgical microscope.  Herein, we present a case of a 54-yr-old female patient presenting with a 1-yr history of numbness of the right lower limb. Neurological examinations demonstrated temperature pain disorder of right lower limb and slight dysuria. Magnetic resonance images demonstrated intradural extramedullary tumor at the level of Th6. Preoperative diagnosis was spinal meningioma.  In this surgical video, we show ICG angiography before dural opening, in addition to the basic surgical procedure of the thoracic meningioma. We believe this operative video will be useful for those in training as well as practicing surgeons. We received written informed consent from the patient for this publication.

scholarly journals Posterior Ankle Arthroscopy for Osteochondromatosis of the Posterior Ankle Extra-Articular Space with a Longitudinal Tear of Flexor Hallucis Longus

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ichiro Tonogai ◽  
Koichi Sairyo
Keyword(s):  
Ankle Arthroscopy ◽  
Flexor Hallucis Longus ◽  
Loose Bodies ◽  
Arthroscopic Technique ◽  
Posterior Ankle Arthroscopy ◽  
History Of ◽  
History Of Pain ◽  
The Right ◽  
Longitudinal Tear

We report a rare case of osteochondromatosis of the posterior ankle extra-articular space with a longitudinal tear of flexor hallucis longus (FHL). A 77-year-old woman was referred to our hospital with an approximately 4-year history of pain and swelling in the right posterior ankle joint without obvious trauma. The pain had worsened in the previous 2 years. On presentation, she had tenderness at the posteromedial and posterolateral ankle. Imaging revealed several ossified loose bodies in the posterior ankle extra-articular space. We removed the loose bodies, performed tenosynovectomy around the FHL, and released the FHL tendon using a posterior arthroscopic technique via standard posterolateral and posteromedial portals. A longitudinal tear and fibrillation were detected in the FHL. The patient was able to return to her daily activities approximately 3 weeks after surgery. At the 1-year follow-up visit, she continued to have minor discomfort and slight swelling on the posteromedial aspect of the right ankle but had no recurrence of the ossified loose bodies. To our knowledge, this is the first report of osteochondromatosis of the posterior ankle extra-articular space with a longitudinal tear of the FHL that was treated by removal of loose bodies, tenosynovectomy around the FHL, and release of the FHL tendon via posterior ankle arthroscopy.

scholarly journals Removal of an Upper Third Molar from the Maxillary Sinus

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Klinger de Souza Amorim ◽  
Vanessa Tavares da Silva ◽  
Rafael Soares da Cunha ◽  
Maria Luisa Silveira Souto ◽  
Carla Rocha São Mateus ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Third Molar ◽  
Maxillary Bone ◽  
Know How ◽  
Car Accidents ◽  
History Of ◽  
History Of Pain ◽  
The Right ◽  
Upper Third ◽  
Surgical Unit

The maxillary sinus or antrum is the largest of the paranasal sinuses. It is located in the maxillary bone and has a proximity to the apexes of upper molars and premolars, which allows it to form a direct link between the sinus and the oral cavity. Dislocation of a foreign body or tooth to the interior of a paranasal sinus is a situation that can occur as a result of car accidents, firearm attacks, or iatrogenic in surgical procedures. Therefore, it is necessary to know how to treat this kind of situation. This study’s objective is to report the case of a 23-year-old female patient, leucoderma, who sought treatment from the Surgical Unit at the Dental Faculty of the Federal University of Sergipe. She had a history of pain and edema in the right side of the genian region and two failed attempts at removing dental unit (DU) 18. The extraoral clinical exam revealed intense edema of the left hemiface with signs of infection, excoriation of the labial commissure, hematoma, a body temperature of 39°C, and a limited ability to open her mouth. The patient was medicated and treated surgically. The tooth was removed from the maxillary sinus with caution, as should have been done initially.

Perimedullary Arteriovenous Fistula of the Filum Terminale

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. E219-E220 ◽  
Author(s):  
Yong Jun Jin ◽  
Ki-Jeong Kim ◽  
O Ki Kwon ◽  
Sang Ki Chung
Keyword(s):  
Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Conus Medullaris ◽  
Leg Pain ◽  
Anterior Spinal Artery ◽  
Filum Terminale ◽  
Segmental Artery ◽  
First Case ◽  
History Of ◽  
The Right

Abstract OBJECTIVE Although a dural or intramedullary arteriovenous fistula involving the conus medullaris and fed by the lateral sacral artery has been reported, a case of perimedullary fistula arising from an artery in the filum terminale has not been described in the literature. The authors report the first case of perimedullary arteriovenous fistula located in the filum terminale. CLINICAL PRESENTATION A 61-year-old man presented with a 10-year history of leg pain. Thoracolumbar magnetic resonance imaging scans revealed multiple perimedullary signal voids from T10 to L3. Angiography showed engorged perimedullary veins and a fistula fed by the anterior spinal artery from the right ninth segmental artery and by 2 branches of the left lateral sacral artery. The anterior spinal artery was also regarded as the artery of the filum terminale. INTERVENTION Transarterial embolization was performed to occlude the feeders from the left lateral sacral artery, and an L5 total laminectomy was subsequently performed to obliterate residual fistulous material from the artery of the filum terminale. The thickened, yellowish filum, surrounded by tortuous, engorged veins, was coagulated and resected. Postoperatively, the patient's symptoms gradually resolved and were not aggravated during long periods of walking. CONCLUSION It must be noted that a fistula can be located in the filum terminale and can be successfully treated using multidisciplinary approaches.

scholarly journals Transforaminal Percutaneous Endoscopic Lumbar Decompression by Using Rigid Bendable Burr for Lumbar Lateral Recess Stenosis: Technique and Clinical Outcome

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Shuo Tang ◽  
Song Jin ◽  
Xiang Liao ◽  
Kun Huang ◽  
Jiaquan Luo ◽  
...  
Keyword(s):  
Back Pain ◽  
Clinical Outcomes ◽  
Visual Analog Scale ◽  
Surgical Procedure ◽  
Leg Pain ◽  
Analog Scale ◽  
Lateral Recess ◽  
Lumbar Decompression ◽  
Lateral Recess Stenosis ◽  
The Mean

Background. Open laminectomy has been regarded as the standard surgical procedure for lumbar lateral recess stenosis during the last decades. Although percutaneous endoscopic lumbar decompression has led to successful results comparable with open decompression, its application in LSS with is still challenging and technically demanding. Here, we report the surgical procedure and preliminary clinical outcomes of transforaminal percutaneous endoscopic lumbar decompression (PELD) by using flexible burr for lumbar lateral recess stenosis. Method. A retrospective study was performed for the patients with lumbar lateral recess stenosis receiving PELD by using flexible burr. The indications of surgery were moderate to severe stenosis, persistent neurological symptoms, and failure of conservative treatment. The patients with mechanical back pain, more than grade I spondylolisthesis, or radiographic signs of instability were not included. Before the operation, the transforaminal epidural lidocaine injections were carried out to make the diagnosis more precise and accurate. Radiologic findings were investigated, and visual analog scale (VAS) for back and leg pain, Oswestry Disability Index, and modified Macnab criteria were analyzed at the different time of preoperation, postoperation, 3 months, 6 months, and 12 months. Results. The follow-up period was 12 months. The mean VAS scores for back and leg pain immediately improved from 7.9 ± 1.2 to 2.8± 1.3, 2.4 ± 1.0, and 2.3 ± 1.0, respectively. The mean visual analog scale scores (VAS) for back pain and leg pain were significantly improved after PELD. The preoperative ODI dropped from 69.1 ± 7.3 to 25.9 ± 8.7, 25.0± 6.9, and 24.7 ± 6.4, respectively. The final outcome was excellent in 39.6%, good in 47.9%, fair in 8.3%, and poor in 4.17%. 87.5% of excellent-to-good ratio was achieved on the basis of Macnab criteria at postoperative 12 months. The complications were limited to transient postoperative dysesthesia (one case), temporary pain aggravation (six cases), and neck pain during the operation (one case). Conclusion. This observation suggests that the clinical outcomes of PELD for lateral recess stenosis were excellent or showed good results. This minimally invasive technique would be helpful in choosing a surgical method for lateral recess stenosis.

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