Incidental detection of bowel herniation with ultrasonography and fluoroscopy during a caudal block

Abstract

Background In contrast to fluoroscopy, ultrasonography allows visualization of structures such as muscles, tendons, vessels, and nerves. We describe a case where ultrasonography in conjunction with fluoroscopy led to the incidental diagnosis of bowel herniation in a patient undergoing a caudal block. Clinical features A 71-yr-old woman presented to our chronic pain clinic with a long-standing history of coccydynia for which she had undergone a partial coccygectomy. A trial caudal block was planned. Fluoroscopy of the lower sacral area revealed the presence of a gas bubble inferoposteriorly to the coccygeal remnant. A confirmatory ultrasound scan revealed a hollow structure compatible with bowel. The procedure was abandoned. Subsequently, a non-enhanced computed tomographic scan of the pelvis confirmed the diagnosis of large bowel herniation. The patient was referred to a colorectal surgeon, and she subsequently underwent successful laparoscopic repair of the coccygeal hernia. Conclusion Ultrasonography can be a valuable adjunct in identifying non-neural pathologies in patients undergoing interventional procedures in chronic pain management. This case report highlights the importance of being vigilant for unanticipated pathologies during ultrasound examinations while performing chronic pain block procedures. RésuméContexte Contrairement a la fluoroscopie, l'e´chographie permet de visualiser des structures telles que les muscles, les tendons, les vaisseaux et les nerfs. Nous de´crivons un cas dans lequel l'e´chographie, en conjonction a`la fluoroscopie, a mene´au diagnostic secondaire d'une hernie intestinale chez une patiente subissant un bloc caudal. É léments cliniques Une femme de 71 ans s'est pre´sente´e a`notre clinique de douleur chronique avec des ante´ce´dents de coccygodynie de longue date, affection pour laquelle elle avait subi une coccygectomie partielle. Un bloc caudal d'essai avait e´te´pre´vu. L'imagerie par fluoroscopie de la zone sacre´e infe´rieure a re´ve´le´la pre´sence d'une bulle de gaz infe´rieure et poste´rieure au coccyx restant. Un e´chogramme de confirmation a re´ve´le´la pre´sence d'une structure vide compatible avec l'intestin. L'intervention a éte´annule´e. Par la suite, une tomographie sans rehaussement du bassin a confirme´le diagnostic d'une hernie intestinale importante. La patiente a e´te´re´fe´re´e à un chirurgien colorectal, et elle a par la suite subi avec succe`s une herniorraphie coccygienne par laparoscopie. Conclusion L'e´chographie peut constituer un ajout pre´cieux pour identifier des pathologies non neurales chez les patients subissant des interventions effractives pour la prise en charge de la douleur chronique. Cette pre´sentation de cas souligne l'importance de garder l'oeil ouvert pour de´tecter des pathologies impre´vues pendant les examens par e´chographie re´alise´s pour un bloc pour la douleur chronique.Compared with fluoroscopy, ultrasonography allows for more accurate visualization of various anatomic structures, including muscles, tendons, vessels, a...

Repair of a coccygeal hernia with a biological mesh

“…Pagenstecher is believed to be the first to report a coccygeal herniation in a 50-year-old woman who had undergone a coccygectomy for coccygodynia [6] . To our knowledge, only 8 cases have been reported with a true coccygeal herniation [6–13] . Because of the small number of reported cased, little is known about the best treatment of this complication.…”

Regional anesthesia in children: the future

“…Central venous access, arterial cannulation, and difficult intubation are but a few examples (18,34,35). Recent reports describing its use for peripheral venous access (36), intraoperative diagnosis of a pneumothorax (37), and unusual pathology (38) bear testimony to the value of ultrasound expertise.…”

The Treatment of Chronic Coccydynia and Postcoccygectomy Pain With Pelvic Floor Physical Therapy

“…Coccygectomy carries immediate risks such as infection, delayed wound healing, and dehiscence (with reported rates anywhere from 15% to 56% [8]). There also have been reports of prolapse of the pelvic organs through the incisional defect, rectal injury, anal sphincter injury, and incontinence [8,18,19]. The bulk of studies on coccygectomy do not have follow‐up beyond 6 months.…”