Unusual Giant Pre-Sacral Multicystic Schwannoma: A Case Report and Differential Diagnosis

Background: Schwannomas are generally benign neoplasms arising from the nerve sheath. Presacral schwannomas are very rare entities and difficult to diagnose, representing less than 15% of all retrorectal space tumors. Benign schwannoma sometimes displays degenerative changes, such as cyst formation, calcification, hemorrhage, and hyalinization. Usually these degenerations are partially seen in the tumors. Objective: To point out that presacral schwannoma can display markedly multilocular cystic degeneration. Case Report: We present this unique case of a 24-year-old man diagnosed with an unusually large pure multilocular cystic schwannoma, which is revealed by digestive, urinary, and nonspecific neurological symptoms. The patient was successfully treated with radical surgery via an anterior approach leading to the recovery of symptoms. Discussion and Conclusion: This tumor was unusual in its totally multicystic appearance and its resemblance to a wide spectrum of lesions that can occur in the pre-sacral space, such as hydatid and developmental cysts. Preoperative diagnosis is essential to prevent major neurological deficits during surgical intervention.

直肠癌手术致骶前静脉损伤大出血的处理

目的 探讨直肠癌术中骶前静脉损伤出血的处理及预防措施。方法 回顾性分析10例直肠癌根治术中损伤骶前静脉致大出血病例。结果 10例中7例术中行纱布填塞压迫止血,3例行骶骨胛图钉按压法止血。10例患者术中止血效果满意,无术后再出血及死亡。结论 骶前纱布垫压迫,骶骨胛图钉按压法是术中骶前静脉损伤发生出血时行之有效的止血方法。直肠癌手术中应高度警惕。

直肠癌术中骶前静脉大出血预防和处理

2008年，美国国家综合癌症网络（NCCN）《直肠癌临床实践指南》以Ⅰ类证据等级推荐拿直肠系膜切除（totalmesorertalexrision，TME）作为中低位直肠癌的标准术式，开启了直肠癌规范化诊治的时代。但是，由于解剖位置的特殊性、复杂的器官毗邻关系，中低位直肠癌手术仍然是各种结直肠手术中并发症发生率最高的术式。