Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, D10-144, Montreal, QC, PQ H3G 1A4, Canada.
Can J Anaesth. 2011 Jun;58(6):551-4. doi: 10.1007/s12630-011-9489-3. Epub 2011 Mar 24.
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.
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.
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.
与透视相比，超声检查可以显示肌肉、肌腱、血管和神经等结构。我们描述了一例患者在接受骶尾部阻滞时，超声检查与透视相结合偶然诊断出肠疝的病例。
一名 71 岁女性因尾骨痛到我院慢性疼痛诊所就诊，她长期患有尾骨痛，并接受了部分尾骨切除术。计划进行骶尾部阻滞试验。下骶骨区域的透视显示，在尾骨残余物的后下方有一个气泡。超声检查显示一个与肠管相符的中空结构。该操作被放弃。随后，盆腔非增强 CT 扫描证实了大肠疝的诊断。患者被转诊给肛肠外科医生，随后成功地进行了腹腔镜下尾骨疝修补术。
超声检查可作为识别接受慢性疼痛管理介入治疗患者中非神经病变的有价值的辅助手段。本病例报告强调了在进行慢性疼痛阻滞操作时，对超声检查中意外发现的病变保持警惕的重要性。
