Edelstein P S, Wong W D, La Valleur J, Rothenberger D A
Department of Obstetrics & Gynecology, University of Minnesota Medical School, Minneapolis, USA.
Dis Colon Rectum. 1996 Aug;39(8):938-42. doi: 10.1007/BF02053995.
Use of endorectal ultrasonography in preoperative evaluation of a presacral lesion is demonstrated.
The natural history, presentation, evaluation, and treatment of presacral lesions in adult patients are presented. The case of a female patient with a presacral carcinoid tumor is presented and discussed.
The patient underwent preoperative evaluation including physical examination, hematologic studies, proctosigmoidoscopy, magnetic resonance imaging, computed tomographic scanning, and endorectal ultrasonography. Ultrasonography proved to be extremely valuable in differentiating tumor compression from tumor invasion of the rectal wall. The patient underwent en bloc excision of the lesion, surrounding tissue, and coccyx. Pathologic diagnosis was carcinoid tumor, possibly replacing a presacral lymph node. Postoperative complete gastrointestinal tract work-up and urinary 5-hydroxyindoleacetic acid analysis along with preoperative imaging revealed no evidence of synchronous lesions or additional metastases.
Presacral lesions are extremely rare entities. The role of endorectal ultrasonography has not been clearly defined. This case demonstrates the value of this simple and safe imaging procedure in detecting bowel wall compression vs. invasion, greatly assisting in planning an operative approach.
展示直肠内超声在骶前病变术前评估中的应用。
介绍成年患者骶前病变的自然病史、临床表现、评估及治疗。呈现并讨论一名患有骶前类癌肿瘤的女性患者病例。
该患者接受了包括体格检查、血液学检查、直肠乙状结肠镜检查、磁共振成像、计算机断层扫描及直肠内超声在内的术前评估。超声检查在区分肿瘤对直肠壁的压迫与侵犯方面被证明具有极高价值。患者接受了病变、周围组织及尾骨的整块切除。病理诊断为类癌肿瘤，可能替代了一个骶前淋巴结。术后完整的胃肠道检查及尿5-羟吲哚乙酸分析，以及术前影像学检查均未发现同步病变或其他转移的证据。
骶前病变极为罕见。直肠内超声的作用尚未明确界定。本病例展示了这种简单且安全的成像检查在检测肠壁受压与侵犯方面的价值，极大地有助于规划手术方案。
