Sacrococcygeal teratomas (SCTs) are uncommon congenital tumors that typically develop in newborns, they are rarely associated with chromosomal abnormalities or other congenital anomalies. The majority of pediatric ter...Sacrococcygeal teratomas (SCTs) are uncommon congenital tumors that typically develop in newborns, they are rarely associated with chromosomal abnormalities or other congenital anomalies. The majority of pediatric teratomas are benign in the neonatal age group, but the risk of malignancy increases with age. Diagnosis is based on a combination of clinical, radiological, and hormonal findings, but confirmed by anatomopathological study. Treatment is primarily surgical, with the aim of achieving complete resection to prevent recurrence. We present the case of a 22-month-old child who was admitted for management of a sacrococcygeal mass and was diagnosed with an immature teratoma.展开更多
Key Facts Synonyms:Sacrococcygeal teratoma(SGT),germ cell tumor of coccyx Definition:Tumors containing hair,teeth,cartilage,and fat extending from the coccyx and potentially growing both internally and externally.
BACKGROUND Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a pa...BACKGROUND Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a patient who had no history of sacrococcygeal operation, present the operative procedures of mesh repair via a combined laparoscopic and sacrococcygeal approach that has not been described,and discuss our experience in diagnosis and treatment with a review of the literature.CASE SUMMARY A 54-year-old woman who chiefly complained of a 10-year history of a reversible bulge in her right sacrococcygeal region was admitted to our hospital. The physical examination revealed a bulge in the right sacrococcygeal region upon standing, which disappeared in the prone position but relapsed when performing the Valsalva manoeuvre. Computed tomography displayed an abnormality in the structure of the tissues between the midline of the sacrococcygeal region and the right gluteus muscle. The patient was diagnosed with sacrococcygeal hernia and received hernia repair with mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally, and a defect was identified in the right anterior sacrococcygeal region through which part of the rectum protruded. This was followed by the placement of a self-gripping polyester mesh via a sacrococcygeal approach. There were no postoperative complications. The patient was discharged on postoperative day 7 and was followed for more than 6 mo with no recurrence.CONCLUSION Laparoscopic mesh repair is recommended as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.展开更多
Background: Teratomas are a type of germ cell tumor, which are mostly benign, and dominative in adult females. Sacococcygeal teratomas are usually found in newborns or children, and can be detected prenatally;they are...Background: Teratomas are a type of germ cell tumor, which are mostly benign, and dominative in adult females. Sacococcygeal teratomas are usually found in newborns or children, and can be detected prenatally;they are exceedingly rare in adults. We reported a case of a sacrococcygeal teratoma in adult female. Case presentation: A 26-year-old female was diagnosed with a presacral tumor 6 years ago. Pelvic computed tomography (CT) demonstrated a presacral heterogeneous tumor, containing multi-located cystic area and enhanced solid component with calcification. Magnetic resonance imaging (MRI) showed a presacral non-enhanced cystic lesion with solid component, 128 mm × 104 mm × 102 mm, which was suspected of having invaded the rectal wall, fifth sacral vertebra (S5), and coccyx. She underwent abdomino-sacral total excision of tumor with coccygectomy. Histopathological examination revealed a tumor with intricate admixture of ectodermal (epidermis, sebaceous glands and squamous), mesenchymal (cartilage, adipose tissue, blood vessels, nerves and skeletal muscle) and endodermal components (respiratory epithelium and intestinal epithelium) respectively. After 24 months of follow-up the patient was both clinically and radiologically disease free. Conclusions: Early complete excision was the preferred definitive modality of treatment for sacrococcygeal teratoma, and multi-staged excision and reconstruction resulted in successful and safe treatment in our case.展开更多
Sacrococcygeal teratoma (SCT) is a common congenital neoplasm, contains derivatives of more than one of the three embryonic germ cell layers. However, malignant Sacrococcygeal Yolk Sac tumor (YST) is an extremely rare...Sacrococcygeal teratoma (SCT) is a common congenital neoplasm, contains derivatives of more than one of the three embryonic germ cell layers. However, malignant Sacrococcygeal Yolk Sac tumor (YST) is an extremely rare extra-gonadal germ cell tumor. This case describes a two and half years old female child presenting with history of swelling at sacrococcygeal region for nine months. Case was evaluated clinically. Patient’s serum alpha fetoprotein (AFP) level was elevated abnormally. FNAC of the swelling was done which shows suspicious cell for immature teratoma. Swelling excised and histopathological examination was carried out, the report of which shows malignant sacrococcygeal teratoma with yolk sac tumor.展开更多
Chordoma as a rare malignant tumor arising from remnants of the fetal notochord accounts for 1%-4%of primary bone tumors. It is usually predominant in males. Local recurrences are common （44%-78%） and distant metast...Chordoma as a rare malignant tumor arising from remnants of the fetal notochord accounts for 1%-4%of primary bone tumors. It is usually predominant in males. Local recurrences are common （44%-78%） and distant metastases may occur years after the initial presentation. The reported rates of metastases range from 10% to 48%, which are usually accompanied by a sacrococcygeal chordoma. Cases of surgical seeding and intradural spinal seeding also have been reported climcally. To our knowledge, the present case is the first one concerning cerebrospinal fluid metastases and fatal progression of a sacrococcygeal chordoma.展开更多
Background Perforator flaps are used extensively in repairing soft tissue defects. Superior gluteal artery perforator flaps are used for repairing sacral defects, but the tension required for direct closure of the don...Background Perforator flaps are used extensively in repairing soft tissue defects. Superior gluteal artery perforator flaps are used for repairing sacral defects, but the tension required for direct closure of the donor area after harvesting of relatively large flaps carries a risk of postoperative dehiscence. This research was to investigate a modified superior gluteal artery perforator flap for repairing sacrococcygeal soft tissue defects. Methods From June 2003 to April 2010, we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients （study group）. The wound and donor areas were measured, and the flaps were designed accordingly. Wound healing was assessed over a follow-up period of 6-38 months. From January 1998 to February 2003, twelve patients with sacrococcygeal pressure sores were treated with traditional methods, VY advancement flaps or oblong flaps, as control group. Results After debridement, the soft tissue defects ranged from 12 cm× 10 cm to 26 cm× 22 cm （mean 16.3 cm× 13.5 cm）. Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm （mean 18.2 cm × 14 cm）. Four patients were treated using left-sided flaps, and two were treated using both right- and left-sided flaps. Suction drains were removed on postoperative Days 3-21 （mean 5.9） and sutures were removed on postoperative Days 12-14. Each flap included 1-2 perforators for each of the donor and recipient sites. Donor sites were closed directly. All flaps survived. In eight patients, the wounds healed after single-stage surgery. After further debridement, the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33, respectively. The rate of first intention in the study group （80%, 8/10） significantly increased than that of control group （（25%, 3/12）, X2=4.583, P=0.032）. Follow-up examinations found that the flaps had a soft texture without ulceration. In the two patients without paraplegia, the range of motion of the hip joints was not affected. Conclusion The use of the quadrilobed superior gluteal artery perforator flap can overcome the disadvantages of traditional perforator flaps and represents an improved approach for repairing soft tissue defects in the sacrococcygeal region.展开更多
Introduction: This study aimed to evaluate, discuss and illustrate the role of fetoscopy diagnostically and therapeutically. Material and Methods: This study was conducted in private center in under the supervision of...Introduction: This study aimed to evaluate, discuss and illustrate the role of fetoscopy diagnostically and therapeutically. Material and Methods: This study was conducted in private center in under the supervision of the professors of Azhar University, Egypt from Dec-2012 to Mar-2017. Women with confirmed fetal congenital malformations, and willing to do fetoscopy were recruited. Fetoscopy was attempted in all cases to treat the underlying fetal conditions. Follow up was made until delivery. Results: Twenty patients with 22 fetuses were included in this study with different congenital anomalies. Therapeutic drainage or coagulation was made in all cases. In cases of lower urinary tract obstruction, fetoscopy confirmed pre-suspected urethral atresia and changed the diagnosis from complete PUV to urethral atresia in some cases. The procedure succeeded in all cases. However, the on-going success rate was 17 (77.3%) of fetuses. The overall number of live birth was 11 fetuses (50%). Overall, 15 (75%) of the 20 patients experienced some complication withpreterm labor the most prevalent 15 (75%). Conclusion: Fetoscopy can diagnose and differentiate between posterior urethral valve (PUV) and atresia, and manage well-selected cases of twin to twin transfusion syndrome (TTTS), and have a reasonable survival rate in lower urinary tract obstruction (LUTO).展开更多
Background:Sacral pressure ulcers are associated with high morbidity and,in some cases,result in mortality from severe sepsis.Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers.An i...Background:Sacral pressure ulcers are associated with high morbidity and,in some cases,result in mortality from severe sepsis.Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers.An ideal flap should be simple to design,have a reliable vascular supply and minimal donor site morbidity.Our study evaluates the use of a bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery to reconstruct the sacral pressure ulcer.Case presentation:We performed a retrospective analysis of paraplegic patients with sacral pressure ulcers treated with our bilobed flaps from January 2015 to December 2019.A description of our management,operative protocol,outcome and complications is outlined.Seven paraplegic patients(6 male,1 female;average age 53.1 years)with sacral pressure ulcers were treated with our bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery.The average size of the pressure ulcers was 7×5 cm(range 6.2×4.5 cm to 11×10 cm).All 7 flaps survived.The patients were followed up for 12 months without significant complications,such as flap necrosis or recurrence.Conclusions:The superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery reliably supplies the bilobed flap.The superior cluneal nerve can be included in the design.The technique is simple and reliable.It should be included in the reconstructive algorithm for the management of sacral pressure ulcers.展开更多
文摘Sacrococcygeal teratomas (SCTs) are uncommon congenital tumors that typically develop in newborns, they are rarely associated with chromosomal abnormalities or other congenital anomalies. The majority of pediatric teratomas are benign in the neonatal age group, but the risk of malignancy increases with age. Diagnosis is based on a combination of clinical, radiological, and hormonal findings, but confirmed by anatomopathological study. Treatment is primarily surgical, with the aim of achieving complete resection to prevent recurrence. We present the case of a 22-month-old child who was admitted for management of a sacrococcygeal mass and was diagnosed with an immature teratoma.
文摘Key Facts Synonyms:Sacrococcygeal teratoma(SGT),germ cell tumor of coccyx Definition:Tumors containing hair,teeth,cartilage,and fat extending from the coccyx and potentially growing both internally and externally.
文摘BACKGROUND Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a patient who had no history of sacrococcygeal operation, present the operative procedures of mesh repair via a combined laparoscopic and sacrococcygeal approach that has not been described,and discuss our experience in diagnosis and treatment with a review of the literature.CASE SUMMARY A 54-year-old woman who chiefly complained of a 10-year history of a reversible bulge in her right sacrococcygeal region was admitted to our hospital. The physical examination revealed a bulge in the right sacrococcygeal region upon standing, which disappeared in the prone position but relapsed when performing the Valsalva manoeuvre. Computed tomography displayed an abnormality in the structure of the tissues between the midline of the sacrococcygeal region and the right gluteus muscle. The patient was diagnosed with sacrococcygeal hernia and received hernia repair with mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally, and a defect was identified in the right anterior sacrococcygeal region through which part of the rectum protruded. This was followed by the placement of a self-gripping polyester mesh via a sacrococcygeal approach. There were no postoperative complications. The patient was discharged on postoperative day 7 and was followed for more than 6 mo with no recurrence.CONCLUSION Laparoscopic mesh repair is recommended as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.
文摘Background: Teratomas are a type of germ cell tumor, which are mostly benign, and dominative in adult females. Sacococcygeal teratomas are usually found in newborns or children, and can be detected prenatally;they are exceedingly rare in adults. We reported a case of a sacrococcygeal teratoma in adult female. Case presentation: A 26-year-old female was diagnosed with a presacral tumor 6 years ago. Pelvic computed tomography (CT) demonstrated a presacral heterogeneous tumor, containing multi-located cystic area and enhanced solid component with calcification. Magnetic resonance imaging (MRI) showed a presacral non-enhanced cystic lesion with solid component, 128 mm × 104 mm × 102 mm, which was suspected of having invaded the rectal wall, fifth sacral vertebra (S5), and coccyx. She underwent abdomino-sacral total excision of tumor with coccygectomy. Histopathological examination revealed a tumor with intricate admixture of ectodermal (epidermis, sebaceous glands and squamous), mesenchymal (cartilage, adipose tissue, blood vessels, nerves and skeletal muscle) and endodermal components (respiratory epithelium and intestinal epithelium) respectively. After 24 months of follow-up the patient was both clinically and radiologically disease free. Conclusions: Early complete excision was the preferred definitive modality of treatment for sacrococcygeal teratoma, and multi-staged excision and reconstruction resulted in successful and safe treatment in our case.
文摘Sacrococcygeal teratoma (SCT) is a common congenital neoplasm, contains derivatives of more than one of the three embryonic germ cell layers. However, malignant Sacrococcygeal Yolk Sac tumor (YST) is an extremely rare extra-gonadal germ cell tumor. This case describes a two and half years old female child presenting with history of swelling at sacrococcygeal region for nine months. Case was evaluated clinically. Patient’s serum alpha fetoprotein (AFP) level was elevated abnormally. FNAC of the swelling was done which shows suspicious cell for immature teratoma. Swelling excised and histopathological examination was carried out, the report of which shows malignant sacrococcygeal teratoma with yolk sac tumor.
文摘Chordoma as a rare malignant tumor arising from remnants of the fetal notochord accounts for 1%-4%of primary bone tumors. It is usually predominant in males. Local recurrences are common （44%-78%） and distant metastases may occur years after the initial presentation. The reported rates of metastases range from 10% to 48%, which are usually accompanied by a sacrococcygeal chordoma. Cases of surgical seeding and intradural spinal seeding also have been reported climcally. To our knowledge, the present case is the first one concerning cerebrospinal fluid metastases and fatal progression of a sacrococcygeal chordoma.
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 30971128）.
文摘Background Perforator flaps are used extensively in repairing soft tissue defects. Superior gluteal artery perforator flaps are used for repairing sacral defects, but the tension required for direct closure of the donor area after harvesting of relatively large flaps carries a risk of postoperative dehiscence. This research was to investigate a modified superior gluteal artery perforator flap for repairing sacrococcygeal soft tissue defects. Methods From June 2003 to April 2010, we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients （study group）. The wound and donor areas were measured, and the flaps were designed accordingly. Wound healing was assessed over a follow-up period of 6-38 months. From January 1998 to February 2003, twelve patients with sacrococcygeal pressure sores were treated with traditional methods, VY advancement flaps or oblong flaps, as control group. Results After debridement, the soft tissue defects ranged from 12 cm× 10 cm to 26 cm× 22 cm （mean 16.3 cm× 13.5 cm）. Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm （mean 18.2 cm × 14 cm）. Four patients were treated using left-sided flaps, and two were treated using both right- and left-sided flaps. Suction drains were removed on postoperative Days 3-21 （mean 5.9） and sutures were removed on postoperative Days 12-14. Each flap included 1-2 perforators for each of the donor and recipient sites. Donor sites were closed directly. All flaps survived. In eight patients, the wounds healed after single-stage surgery. After further debridement, the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33, respectively. The rate of first intention in the study group （80%, 8/10） significantly increased than that of control group （（25%, 3/12）, X2=4.583, P=0.032）. Follow-up examinations found that the flaps had a soft texture without ulceration. In the two patients without paraplegia, the range of motion of the hip joints was not affected. Conclusion The use of the quadrilobed superior gluteal artery perforator flap can overcome the disadvantages of traditional perforator flaps and represents an improved approach for repairing soft tissue defects in the sacrococcygeal region.
文摘Introduction: This study aimed to evaluate, discuss and illustrate the role of fetoscopy diagnostically and therapeutically. Material and Methods: This study was conducted in private center in under the supervision of the professors of Azhar University, Egypt from Dec-2012 to Mar-2017. Women with confirmed fetal congenital malformations, and willing to do fetoscopy were recruited. Fetoscopy was attempted in all cases to treat the underlying fetal conditions. Follow up was made until delivery. Results: Twenty patients with 22 fetuses were included in this study with different congenital anomalies. Therapeutic drainage or coagulation was made in all cases. In cases of lower urinary tract obstruction, fetoscopy confirmed pre-suspected urethral atresia and changed the diagnosis from complete PUV to urethral atresia in some cases. The procedure succeeded in all cases. However, the on-going success rate was 17 (77.3%) of fetuses. The overall number of live birth was 11 fetuses (50%). Overall, 15 (75%) of the 20 patients experienced some complication withpreterm labor the most prevalent 15 (75%). Conclusion: Fetoscopy can diagnose and differentiate between posterior urethral valve (PUV) and atresia, and manage well-selected cases of twin to twin transfusion syndrome (TTTS), and have a reasonable survival rate in lower urinary tract obstruction (LUTO).
基金supported by funding from the following programs:The National Natural Science Foundation of China(Grant Number:81772098)the Clinical Multi-Disciplinary Team Research Program of the Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine+1 种基金the Clinical Research Program of the Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicineand the Shanghai Municipal Education Commission Gaofeng Clinical Medicine Grant Support.
文摘Background:Sacral pressure ulcers are associated with high morbidity and,in some cases,result in mortality from severe sepsis.Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers.An ideal flap should be simple to design,have a reliable vascular supply and minimal donor site morbidity.Our study evaluates the use of a bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery to reconstruct the sacral pressure ulcer.Case presentation:We performed a retrospective analysis of paraplegic patients with sacral pressure ulcers treated with our bilobed flaps from January 2015 to December 2019.A description of our management,operative protocol,outcome and complications is outlined.Seven paraplegic patients(6 male,1 female;average age 53.1 years)with sacral pressure ulcers were treated with our bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery.The average size of the pressure ulcers was 7×5 cm(range 6.2×4.5 cm to 11×10 cm).All 7 flaps survived.The patients were followed up for 12 months without significant complications,such as flap necrosis or recurrence.Conclusions:The superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery reliably supplies the bilobed flap.The superior cluneal nerve can be included in the design.The technique is simple and reliable.It should be included in the reconstructive algorithm for the management of sacral pressure ulcers.
