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At least 181 records · Page 10Linked to original sources
PubMed1995

Autonomic nerves cross the posterior plane of rectal dissection.

This investigation was an anatomical study to determine whether branches of the pre-sacral autonomic plexus cross the posterior plane of surgical dissection to supply the rectum. Initially four cadaver hemi-pelves were dissected. Twelve patients undergoing full rectal mobilization were then studied at operation. In all subjects the pre-sacral nerves were arranged as a plexus below the sacral promontory, rather than as individual left and right nerve trunks. Structures thought to be nerves were identified crossing the plane of posterior mobilization of the rectum. They were traced towards their origin and destination, photographed and representative fibres biopsied. A total of 42 such structures were biopsied (16 in cadavers, 26 in operative cases) and 40 were confirmed to be nerves. These nerves connect the pre-sacral autonomic plexus with the posterior aspect of the rectum and were found at all sacral levels. In the operative cases the level of the positive biopsies were S1-six, S2-six, S3-five, S4-four, S5-three. The posterior plane of rectal dissection is therefore crossed by autonomic nerves that innervate the rectum. The pre-sacral nerves have been found to form a plexus in all subjects.

Adult↗
PubMed2004

Anterior sacral meningocele with presacral cysts: report of a case.

Anterior sacral meningocele is a rare anomaly most frequently presenting as a presacral mass. Since the first description in 1837, approximately 150 cases have been reported. The case presented is a 37-year-old female in whom an asymptomatic presacral mass was discovered during her first delivery. Because normal delivery was impossible, a cesarean section was performed. A year later, in a regional hospital a "cystic presacral tumor" was treated with biopsy and drainage. Four years later, she developed constipation caused by perineal compression for which she was admitted to our department in which two anterior presacral cysts were excised. The recovery was complicated with meningitis, which was successfully treated with antibiotics. Whenever a presacral mass is found, anterior sacral meningocele has to be a diagnostic consideration. The symptoms are usually related to the compression on rectum, bladder, and sacral nervous plexus. Rectal examination and radiography of the pelvis with the sacral bone showing the "scimitar sign" are the main diagnostic methods. Myelography, computed tomography, and magnetic resonance imaging are the best methods for identifying the precise anatomy of sacral meningocele and for proper planning of the operation. Transvaginal or transrectal aspiration and drainage are not advised, because they may result in a lethal outcome caused by sepsis.

Anti-Bacterial Agents↗
PubMed1989

Neuroanatomy of the pelvis in an infant with cloacal exstrophy: a detailed microdissection with histology.

The internal anatomy of the pelvis in the patient with cloacal exstrophy has not been described in detail previously. We present in detail the pelvic anatomical relationships of a patient with cloacal exstrophy who died 72 days after birth and whose body subsequently was perfused with a formalin-based anatomical fluid. Microdissection of the pelvis with histological confirmation of the identity of structures dissected was performed. The vascular supply to the urinary hemibladders arises from the internal iliac arteries, which pass along the lateral portion of the pelvis and enter each hemibladder. The autonomic innervation to the bladder and corporeal bodies arises from a pelvic plexus that lies on the anterior surface of the sacrum. The innervation to the hemibladders then travels in the midline along the posteroinferior surface of the pelvis before extending laterally to communicate with each hemibladder. Autonomic innervation to the duplicated corporeal bodies arises from the sacral pelvic plexus and travels in the midline to pierce the inferior portion of the pelvic floor posterior and medial to the hemibladders. These nerves then enter the crural region of the corpora. Sensory innervation to the corporeal bodies arises from the sacral trunk and passes posterior to the pelvic floor muscles, traveling just medial to the widely separated ischial spines and then laterally along the corporeal bodies. Illustrations of the anatomy and implications for management of the exstrophy patient are presented.

Abnormalities, Multiple↗
PubMed1987

[An anatomical study of the root sleeve emergence and its relation to segmental anomalies of the lumbo-sacral spine].

An anatomical study was done of 102 plexuses in 51 human white cadavers, of which 35 had normal segmental arrangement of the lumbo-sacral spine and 16 transitional vertebrae. The lumbo-sacral plexus was symmetric in 42 specimens, and asymmetrical in 9. In normal segmental arrangement of the lumbo-sacral spine, the normal type of plexus occurred in 86.7% of the dissections, and prefixed type in 3.3%. In lumbarization, 8 out of 18 plexuses presented the postfixed type of plexus, and this corresponded to one half of the partial type of lumbarization. In sacralization, 6 out of 14 plexuses showed the prefixed type of plexus, and this also corresponded to one half of the complete type of sacralization. In those instances in which the lumbar spine was diminished in number, as evidenced by the shortening of the 12th ribs, 23.5% of the plexuses have shifted cranially.

Humans↗
PubMed2002

Anesthetic pain management in Siriraj Hospital: a retrospective review.

Neural blockade has been used as the single method to anesthetize a part of the body or used in combination with general anesthesia to lessen perioperative pain. Currently, nerve blocks are used for diagnostic, prognostic, therapeutic and prophylactic proposes for management of chronic, acute and cancer pain in a Pain Clinic. Reviewing the records of the 3,349 patients at Siriraj Pain Clinic, we found 2,662 and 687 cases had chronic and acute pain problems respectively, and only 646 patients were treated with anesthetic interventions during 1990 to 1998. They consisted of 317 male and 329 female. The techniques included stellate ganglion block, paravertebral nerve block, celiac plexus block, hypogastric plexus block, mesenteric plexus block, sacral nerve block, epidural steroid, lumbar sympathectomy, first and second thoracic sympatholysis, facet joints injection, sacroiliac joint injection, intravenous regional block with guanethidine or ketanserin, continuous opioid infusion, intravenous lidocaine infusion, and a phentolamine test. The common problems of pain included brachial plexus injury, chronic spinal pain, herpetic neuralgia, ischemic pain, central post-stroke pain, and causalgia. This retrospective review showed that 38 per cent of them reported 50 per cent pain relief with temporary effect. 34 per cent experienced good and satisfactory pain relief while 9 per cent reported excellent pain relief. 17 per cent did not gain benefit from any technique of pain relief and about 2 per cent could not be evaluated due to they did not return for follow-up. One serious complication after thoracic sympatholysis was brachial plexus injury. The neural blockade is proven to be one of the useful adjunct in the management of chronic pain but the selection of the technique is subjected to its critical appraisal.

Female↗
PubMed1988

Neurons projecting rostrally in the hypogastric nerve of the cat.

Afferent, pre- and postganglionic nerve cell bodies projecting rostrally in the hypogastric nerve have been labelled retrogradely with horseradish peroxidase, in order to study number and location of these neurons. Labelled somata were found in the ganglia of the pelvic plexus, in sacral spinal ganglia and in the sacral spinal cord. They were located mainly ipsilateral with a maximum of afferent and preganglionic neurons at the segmental level S2. The numbers of labelled cells were small (less than 3.5% of all axons in the hypogastric nerve) and varied considerably between animals. Therefore this population of neurons is probably small and of limited functional significance. Enteric neurons (probably afferent) that have their cell bodies within the pelvic viscera and project rostrally in the hypogastric nerve to the inferior mesenteric ganglion were not included in this study and might be of more functional importance.

Afferent Pathways↗
PubMed2001

Successful intrauterine shunting of a sacrococcygeal teratoma (SCT) causing fetal bladder obstruction.

We report a case of a sacrococcygeal teratoma (SCT) diagnosed at 22 weeks with a substantial intrapelvic cystic extension leading to bladder outlet obstruction and hydronephrosis at 27 weeks. Prenatal percutaneous shunting of the cystic teratoma was performed at 28 weeks to avoid prolonged fetal pelvic compression by the tumour that could have adverse effects by stretching the pelvic plexus and sacral nerves. Urinary dilatation resolved completely after shunting and a 3880 g baby girl was delivered at 39 weeks. The potential benefits of in utero shunting to avoid urological complications of SCTs with intrapelvic extension are discussed.

Adult↗
PubMed2006

Vascular anatomy of the presacral space in unembalmed female cadavers.

OBJECTIVE: The purpose of this study was to characterize the vascular anatomy of the female presacral space (PSS) and to correlate findings to the abdominal sacrocolpopexy. STUDY DESIGN: Detailed dissections of the PSS were performed in 52 unembalmed female cadavers. RESULTS: The closest cephalad vessel to the mid sacral promontory (MSP) was the left common iliac vein (LCIV), mean distance 27 mm (9-52 mm). The closest vessel lateral to MSP was also the LCIV, mean distance 22 mm (9-35 mm). The average distance of the middle sacral artery and vein to the MSP was 4 mm (0-15 mm) and 7 mm (0-17 mm), respectively. The mean distance of the sacral venous plexuses to the MSP was 34 mm (4-86 mm). CONCLUSION: Anatomic location of the vascular boundaries and contents of the PSS is highly variable. Careful dissection and exposure of the anterior longitudinal ligament of the sacrum before suture placement should minimize potentially life-threatening vascular complications.

Aged↗
PubMed1994

Lower urinary tract dysfunction in children with benign sacrococcygeal teratoma.

We evaluated 8 girls and 3 boys with benign sacrococcygeal teratoma for lower urinary tract dysfunction. All children underwent ultrasonography of the urinary tract, voiding cystourethrography and at least 2 standard urodynamic evaluations. Mean patient age at first urodynamic study was 59 months (range 1 to 136). Nine of the 11 children had abnormal studies, including detrusor instability and associated pelvic floor overactivity during micturition in 2, an anatomical infravesical obstruction in 2 and neurogenic bladder-sphincter dysfunction in 5 (2 detrusor hyperreflexia with sphincter dyssynergia, 2 hyporeflexic bladder-sphincter function and 1 detrusor hyporeflexia with normal sphincter function). Although the major cause of neurogenic lower urinary tract dysfunction seems to be related to surgical trauma of the pelvic plexus and sacral nerves, we observed tethered spinal cord as a primary cause in 2 patients. The incidence of voiding dysfunction in children with sacrococcygeal teratoma is high and is usually neurogenic in origin.

Abdominal Neoplasms↗
PubMed1995

Morbidity and mortality following preoperative radiation therapy and total pelvic exenteration for primary rectal adenocarcinoma.

BACKGROUND: Pelvic exenteration, the standard treatment for patients with locally advanced rectal adenocarcinoma infiltrating neighbouring pelvic visceras, carried a significant morbidity and mortality rate. AIMS: The aim of this study was to determine the morbidity and mortality rates in a group of patients who were treated with preoperative radiation therapy and total pelvic exenteration. METHODS: Between January 1980 and January 1995, we treated 18 patients. Pretreatment staging was determined by clinical examination and computed tomography (CT) scan of the abdomen and pelvis. Each patient received preoperative radiation therapy of 45 Gy in 20 fractions delivered to the whole pelvis; approximately 6 weeks later total pelvic exenteration was performed. RESULTS: There were 17 males and 1 female, with a median age of 59 years. All patients underwent and completed the scheduled radiation therapy treatment. The main complaints related to radiotherapy were transient skin erythema in five patients and diarrhoea in four. Blood loss (estimated by the surgeon) ranged from 1000 ml to 4200 ml, with a mean loss of 2020 ml. Eight patients (44%) developed major complications: anastomatic leak from the uretero-intestinal suture line (n = 1); perineal wound infection (n = 2); abnormal wall infection (n = 1); haemorrhage from the right internal iliac vein (n = 1) and pneumonia (n = 1). Three patients required surgical reintervention for immediate postoperative haemorrhage from the sacral venous plexus (n = 1), small bowel obstruction (n = 1), and intra-abdominal and pelvic abscess (n = 1). There were two postoperative deaths (11%). The mean and median follow-up was 41 and 32 months, respectively. Two patients (12%) developed local recurrence at 5 and 8 months, and six developed distant recurrences (37%). The overall 5-year survival rate was 61%. CONCLUSION: Our treatment approach was associated with high morbidity and mortality rates, but was similar to previously published series based on total pelvic exenteration without prior radiation therapy. In addition, our therapeutic approach was associated with a low rate of overall local recurrences. Surgical Oncology 1995; 4: 295-301.

Adenocarcinoma↗