Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka.
University Hospital-General Sir John Kotelawala Defence University, Colombo, Sri Lanka.
J Med Case Rep. 2021 Sep 14;15(1):455. doi: 10.1186/s13256-021-03012-z.
Cauda equina syndrome is a rare clinical condition that requires prompt diagnosis and timely surgical decompression with postoperative rehabilitation to prevent devastating complications.
A 55-year-old Sinhalese woman presented with a vulval abscess, with a history of involuntary leakage of urine for the last 7 years. Her sexual activity has been compromised due to coital incontinence, and she had also been treated for recurrent urinary tract infections during the last 7 years. On examination, a distended bladder was found. Neurological examination revealed a saddle sensory loss of S2-S4 dermatomes. There was no sensory loss over the lower limbs. Bladder sensation was absent, but there was some degree of anal sphincter tone. Motor functions and reflexes were normal in the limbs. Magnetic resonance imaging revealed L5-S1 spondylolisthesis. Ultrasound imaging confirmed the finding of a distended bladder, in addition to bilateral hydroureters with hydronephrosis. An incision and drainage with concomitant intravenous antibiotics were started for the vulval abscess. An indwelling catheter was placed to decompress the bladder and to reduce vulval excoriations due to urine. Bilateral ureteric stenting was performed later for persistent hydronephrosis and hydroureter despite an empty bladder.
This is a tragic case that illustrates the devastating long-term sequelae that ensues if cauda equina syndrome is left undiagnosed. It reiterates the importance of prompt referral and surgical decompression.
马尾综合征是一种罕见的临床病症，需要及时诊断和手术减压，并进行术后康复，以预防严重的并发症。
一位 55 岁的僧伽罗女性因外阴脓肿就诊，她在过去 7 年中出现不自主漏尿，性生活受到影响，因性交失禁，她也在过去 7 年中反复发生尿路感染。检查发现膀胱膨隆。神经系统检查显示 S2-S4 皮节鞍区感觉丧失。下肢无感觉丧失。膀胱感觉缺失，但肛门括约肌张力有一定程度。四肢运动功能和反射正常。磁共振成像显示 L5-S1 脊椎滑脱。超声成像证实了膀胱膨隆的发现，同时双侧输尿管积水伴肾积水。外阴脓肿切开引流并同时给予静脉抗生素治疗。由于持续存在肾积水和输尿管积水，尽管膀胱排空，仍留置导尿管以减轻膀胱压迫和外阴擦伤。
这是一个悲惨的病例，说明了马尾综合征如果未得到诊断，将会产生严重的长期后果。它再次强调了及时转诊和手术减压的重要性。
