Congenital Sacrococcygeal Cyst of Ependymal Origin

MRS. V. W., aged 43, was admitted to the Middlesex Hospital, under the care of Mr. Victor Bonney, on May 12, 1923. She gave the following history: At the age of 13, pain of an aching character was felt at the bottom of the spine, and it was about the same time that her parents noticed a fullness of the right buttock. Owing to the gradual increase in size of the swelling, advice was sought at Birmingham a year later, and operation advised. In the same year the swelling was removed through a right gluteal incision by the late Mr. Jordan Lloyd. Eighteen years later, at the age of 32, the swelling reappeared, and a second operation for its removal was performed through a similar incision by Sir Gilbert Barling. She married in 1917 at the age of 37, and in September, 1920, a full-time living child was born, without complications with the exception of a badly torn perineum. She became pregnant for a second time in September, 1922, and it was about this time that she noticed the reappearance of the swelling in the right buttock, which steadily increased in size, but it was not until the end of April, 1923, when she was about eight months' pregnant, that she consulted her doctor. On admission to hospital the following month, the fundus of the uterus had reached the infrasternal angle. The child's head was floating above the pelvic brim, and could not be made to engage. On vaginal examination, a cystic swelling could be felt filling the pelvis, pushing the posterior vaginal wall forwards against the symphysis pubis and the rectum against the left side of the pelvis. The cervix could not be reached. The cystic swelling in the pelvis was continuous with a large cystic swelling in the right buttock and coccygeal region (see fig. 1). Owing to an accident to Mr. Victor Bonney, Mr. Comyns Berkeley performed Caesarean section on May 30, and a healthy living child was delivered. It was then seen that a retroperitoneal cyst was firmly wedged in the pelvis. The appendages of both sides were noted to be healthy. With the intention of obtaining better access to the cyst the body of the uterus was removed. At the anesthetist's request, however, no attempt was made to remove the cyst on account of the already rather extensive loss of blood. It was therefore tapped from above and about four pints of light brown fluid withdrawn. After a rapid recovery the patient was sent to the Middlesex Hospital Convalescent Home seventeen days later. On September 3, three months after the operation, she was again admitted to the Middlesex Hospital, where it was found that the cyst had refilled. On deep palpation above the symphysis pubis the cystic swelling with a smooth upper surface could be felt rising from the pelvis.

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Congenital Sacrococcygeal Cyst of Ependymal Origin

Cited by 4 publications

References 3 publications

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