Symptom >> Surgical >> Neurosurgery

Pelvic meningocele

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Spinal meningocele is a common type of partial spina bifida. It refers to the swelling of the spinal canal and/or spinal nerve tissue into the spinal canal based on the spina bifida. If the spinal nerve tissue and the meninges bulge at the same time, and the bulging sac has intact skin or pseudo-epithelial coverage, it is called meningocele bulging. The pelvic sulcus is derived from the defect of the anterior wall of the tibia.

Cause

Cause

Due to congenital factors, laminectomy is incomplete, and there is a cause of swelling of the spinal cord and nerve to the lamina defect. It is still unclear that this disease occurs mostly in the midline of the dorsal aspect of the spine. The most common lumbosacral segment occurs in the cervical segment. Or chest. In some cases, the protrusion from the vertebrae to the side of the spinal canal through the enlarged intervertebral foramen, or the bulging sac to the posterior pharyngeal wall, the thoracic cavity and the pelvic cavity, the bulging of the meninges is generally less common in single-shot multiples. Meningocele sometimes coexists with congenital hydrocephalus.

Examine

an examination

Related inspection

Pelvic inflation angiography X-ray lipiodol angiography MRI

Clinical constipation, urinary dysfunction and dystocia. The manifestations of meningocele and spinal meningocele can be divided into three aspects:

1. When a baby is born, a cystic mass can be seen in the neck, chest or lumbosacral region of the midline of the back. The volume varies from jujube to huge. The mass is round or elliptical, with a wide base and a few ribbons. The surface of the skin is normal, sometimes with a scar-like change, or a thin layer. When the baby is crying, the mass is swollen, and the compression mass is bulging. In the case of a ulceration, there is only one layer of arachnoid membrane on the surface defect, which is granulated or infected. In the case of ulceration, the surface of the mass has cerebrospinal fluid outflow, indicating that the bulging capsule communicates with the subarachnoid space. The light transmission test of the mass was found to have a high degree of light transmission in simple meningocele; for the spinal meninges, because there are spinal cords and nerve roots, some of the blocks have shadows; If the meningocele or the meningocele of the spinal cord is combined with lipoma, the surface is covered with adipose tissue, and the deep surface is the meningocele, so the degree of light transmission is low.

2. Symptoms of nerve damage: simple meningocele can have no neurological symptoms. Spinal meningocele and spinal cord developmental deformity, degeneration, formation of syringomyelia, the symptoms are more serious, often have varying degrees of lower extremity paralysis and incontinence. The symptoms of severe neurological damage caused by lumbosacral lesions are far more than those of cervical and thoracic lesions. These neurological symptoms include deformed feet (such as varus, valgus, dorsal curvature and small feet), muscle atrophy, unequal length of the lower limbs with numbness, weakness and autonomic dysfunction. The tethered cord of the spinal cord and meningocele itself can be further aggravated with age and length of the tethered cord syndrome. Spinal cord exposure usually shows severe neurological symptoms and is also determined by the degree of spinal deformity.

3. Other symptoms: a small number of meningocele bulging to the lateral side of the spinal canal or the posterior pharyngeal wall, thoracic cavity, abdominal cavity and pelvic cavity extension, can show the symptoms of bulging sac compression of adjacent organs and organs. Some children with meningocele with other malformations such as hydrocephalus and scoliosis may have corresponding symptoms.

According to the above clinical symptoms, it is generally possible to make a diagnosis. The light transmission test can be used as a reference for diagnosis. The most critical diagnostic point is that the baby's midline, expansive mass is found after birth and expands with age, as well as the accompanying symptoms of neurological damage.

Diagnosis

Differential diagnosis

There is a wide infiltration in the pelvic cavity: rectal cancer spreads out of the intestinal wall, and when there is extensive infiltration in the pelvic cavity (or recurrence in the pelvic cavity after surgery), it can cause soreness in the waist and ankle, and a feeling of swelling. Symptoms caused by local infiltration: rectal cancer spread out of the intestinal wall when there is extensive infiltration in the pelvic cavity (or recurrence in the pelvic cavity after surgery), which can cause pain in the waist and ankle, swelling feeling; when the tumor infiltrates or compresses the sciatic nerve or closes Sciatic nerve pain or obturator neuralgia may also occur in the sacral nerve root (lumbosacral plexus); vaginal bleeding or hematuria may occur when the tumor invades the vagina and bladder mucosa; colon cancer may invade and contact with the small intestine After the formation of internal hemorrhoids, there may be postprandial diarrhea, which discharges the symptoms of not completely digesting the food; if the tumor involves the ureter, hydronephrosis may occur. If the bilateral ureter is involved, it may cause urinary closure and uremia, and the pelvic recurrence after rectal cancer operation. And the common cause of death.

Pelvic abscess: Most of the acute pelvic connective tissue inflammation has not been treated in time, and the suppuration forms a pelvic abscess. This abscess can be confined to one or both sides of the uterus, and the pus flows into the deep pelvic cavity. The symptoms continued to deteriorate, and there was a relaxation-type hyperthermia. The peritoneal irritation was more pronounced. There were rectal and bladder irritation such as rectal pressure, defecation and dysuria, and symptoms of systemic poisoning. Double diagnosis and anal examination showed that the pelvic cavity was full, and the rectal uterus was thickened, hard or undulating, accompanied by obvious tenderness.

Vaginal mucosal swelling: a symptom caused by the development of embryonal rhabdomyosarcoma under the skin. According to clinical manifestations and pathological features, it is generally not difficult to diagnose, but it is not easy to diagnose early in clinical practice. When a child is found to have a mass in the vagina, the mass is often quite large and even has a destructive infiltration or metastasis. Sometimes histopathological examination is quite benign and often misunderstood as a benign tumor. Scholars believe that there are longitudinal and transverse striped muscle fibers in the eosinophilic cytoplasm, which is the main basis for the diagnosis of rhabdomyosarcoma, but it is difficult to find this striped structure in practice, mainly because of the small number of tumor cells and the sparse structure. Electron microscopy helps to confirm the appearance of striped muscle structures, and the presence of immature cells in tissue sections is more important for diagnosis.