Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea.
Department of Orthopedic Surgery, Jeju National University Hospital, Jeju 63241, Republic of Korea.
Medicina (Kaunas). 2023 Jul 19;59(7):1331. doi: 10.3390/medicina59071331.
Chronic constipation can lead to fecal impaction in the large bowel, which can cause pressure necrosis followed by perforation, known as a stercoral ulcer. In extensive posterior thoracolumbar surgery, a long operation time, large blood loss, and perioperative narcotic use may aggravate constipation. Moreover, sacral root palsy due to cauda equina syndrome (CES) can lead to the deterioration of fecal impaction. This report describes the case of a 77-year-old woman with CES who presented with saddle anesthesia, neurogenic bladder, bowel incontinence, and paraplegia. Five days prior, she had undergone extended posterior lumbar interbody fusion from L1 to L5. Lumbar magnetic resonance imaging (MRI) showed an extended epidural hematoma. After urgent neural decompression, she gradually recovered from the saddle anesthesia, leg pain, and paraplegia over 3 weeks. Thereafter, the patient suddenly developed massive hematochezia and hemorrhagic shock. Urgent colonoscopy was performed, and a stercoral ulcer in the sigmoid colon was diagnosed. After 4 weeks of intensive care for hemorrhagic shock, pneumonia, and systemic sepsis, the patient was transferred to a general ward for intensive rehabilitation. One year after the operation, she was able to walk with assistance, and her urinary and bowel incontinence completely recovered. Chronic constipation, a common clinical problem, can sometimes cause relatively obscure but potentially life-threatening complications such as stercoral ulceration. Possible factors including advanced age, extensive spinal surgeries, prolonged operation time, significant blood loss, perioperative narcotic use, and the presence of spinal cord injury might contribute to the development of this condition. It highlights the importance of recognizing the potential development of stercoral ulcers in patients with CES and emphasizes the need for prompt diagnosis and management to avert catastrophic complications.
慢性便秘可导致大肠粪便嵌塞，继而引发压力性坏死，导致粪性溃疡，即粪性溃疡。在广泛的胸腰后路手术中，手术时间长、大量失血和围手术期使用麻醉药物可能会加重便秘。此外，马尾综合征（CES）导致的骶神经根麻痹可使粪便嵌塞恶化。本报告描述了一例 CES 患者的病例，该患者表现为鞍区感觉障碍、神经性膀胱、大便失禁和截瘫。五天前，她接受了从 L1 到 L5 的广泛后路腰椎椎体间融合术。腰椎磁共振成像（MRI）显示硬膜外血肿广泛扩展。在紧急神经减压后，她在 3 周内逐渐从鞍区感觉障碍、下肢疼痛和截瘫中恢复。此后，患者突然出现大量血便和失血性休克。紧急结肠镜检查诊断为乙状结肠粪性溃疡。在因失血性休克、肺炎和全身败血症接受 4 周强化治疗后，患者被转至普通病房进行强化康复治疗。手术后 1 年，她能够在辅助下行走，且尿便失禁完全恢复。慢性便秘是一种常见的临床问题，但有时可能会导致相对隐匿但具有潜在生命威胁的并发症，如粪性溃疡。可能的因素包括年龄较大、广泛的脊柱手术、手术时间延长、大量失血、围手术期使用麻醉药物以及存在脊髓损伤，这些因素可能导致该病的发生。这突出了认识 CES 患者中粪性溃疡发生的潜在风险的重要性，并强调了及时诊断和处理以避免灾难性并发症的必要性。
