Intradural disc herniation is a rare entity that occurs most commonly in the lumbar spine particularly at L4-L5 region. Most often it is diagnosed intraoperatively in a case of simple intervertebral disc herniation. Contrast enhanced MRI is mandatory for pre operative diagnosis. We describe a case of a 40-year-old female who presented to us with pain lower back, pain in both lower limbs and urinary retention after a fall. She had previously been diagnosed as a case of prolapsed intervertebral disc disease and was being managed conservatively. An unenhanced MRI revealed a large disc herniation at L4-L5 level. L4 and L5 laminectomy was performed and a hard intradural mass was palpable. On opening the dura a fragment of intervertebral disc was found with a small rent in the anterior dura. The fragment was removed and the rent was sutured. The patient recovered well from the surgery. Intradural disc herniations must be considered in the differential diagnosis of prolapsed intervertebral disc disease especially with recent worsening of symptoms and mismatch of unenhanced MRI findings with intraoperative findings. KeywoRds: Intradural disc, Diagnosis, L4-L5 level, Lumbar disc ÖZİntradural disk herniasyonu en sık olarak lumbar omurgada ve özellikle L4-L5 bölgesinde oluşan nadir bir durumdur. Genellikle basit intervertebral disk herniasyonu durumunda intraoperatif olarak tanı konur. Kontrast maddeli MRG preoperatif tanı için şarttır. Bize bir düşmeden sonra bel ağrısı, her iki bacakta ağrı ve üriner retansiyonla gelen 40 yaşında bir kadın vakayı sunuyoruz. Daha önce prolapse intervertebral disk hastalığı tanısı konmuştu ve konservatif olarak takip ediliyordu. Kontrast maddesiz MRG L4-L5 seviyesinde büyük bir disk herniasyonu gösterdi. L4 ve L5 laminektomi yapıldı ve sert bir intradural kitle palpe edildi. Dura açıldığında anterior durada küçük bir yırtıkla birlikte küçük bir intervertebral disk parçası bulundu. Parça çıkarıldı ve yırtık dikildi. Hastanın durumu cerrahiden sonra düzeldi. İntradural disk herniasyonları prolapse intervertebral disk hastalığının ayırıcı tanısında özellikle belirtiler yakın zamanda kötüleşmişse ve kontrast maddesiz MRG bulguları intraoperatif bulgularla eşleşmiyorsa düşünülmelidir.ANAHTAR sÖZCÜKLeR: İntradural disk, Tanı, L4-L5 seviyesi, Lumber disk
Omental cyst is a rare clinical entity and often poses a diagnostic challenge to the surgeon. The incidence is about 1 per 1,000,000 in adults and about 1 per 20,000 pediatric patients. 1 These cases are mostly reported as incidental radiological findings and on laparotomy due to varied clinical presentation.
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