Oh Jacob Y L, Kwek Kevin J H, Tee Seh-Wee, Tan Mark
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
J Spine Surg. 2017 Mar;3(1):108-111. doi: 10.21037/jss.2017.02.08.
A 61-year-old gentleman was admitted with progressive symptoms of cervical myelopathy. An MRI performed showed severe compression from C3-6 with cord signal changes. He was offered surgical intervention but the operation had to be delayed because of worsening abdominal distension. X-rays performed showed a severely dilated colon measuring >12 cm. A CT did not show any obstructive cause. He was managed conservatively for more than 2 weeks but did not improve. As his symptoms continued to worsen, a decision was made to proceed with a C3-6 posterior decompression and fusion, despite the theoretical risk of bacterial translocation predisposing him to infection. Postoperatively, he improved significantly. Interestingly, his abdominal distention had also improved and a repeat X-ray showed complete resolution of the megacolon. In conclusion, this case highlights that long standing cervical cord compression may be a cause for an "atonic" megacolon. Once all causes of intestinal obstruction are excluded, surgical decompression of the cervical stenosis should proceed, and need not be delayed for the megacolon resolve spontaneously.
一名61岁男性因颈椎脊髓病的进行性症状入院。MRI检查显示C3 - 6节段严重受压，伴有脊髓信号改变。他接受了手术干预，但由于腹胀加重，手术不得不推迟。X线检查显示结肠严重扩张，直径>12 cm。CT检查未发现任何梗阻原因。他接受了超过2周的保守治疗，但病情没有改善。由于他的症状持续恶化，尽管存在细菌易位导致感染的理论风险，但还是决定进行C3 - 6后路减压融合术。术后，他明显好转。有趣的是，他的腹胀也有所改善，复查X线显示巨结肠完全消失。总之，该病例表明长期的颈髓压迫可能是“弛缓性”巨结肠的一个原因。一旦排除所有肠梗阻原因，应进行颈椎管狭窄的手术减压，不必因巨结肠自行缓解而延迟手术。
