Yangtze River Daily Great Wuhan Client October 27th Long-term abdominal pain, I underwent appendectomy and intestinal adhesion surgery within one year, but the symptoms have not yet been relieved. Mr. Zhang, 27, with the last glimmer of hope, went to Wuhan University People's Hospital and found that the "real murderer" that caused the abdominal pain was actually the intra-spinal schwannoma in the spine. This tumor almost made him paralyzed for life.
Mr. Zhang lives in Yuancheng District, Wuhan. He went to the local hospital for treatment a year ago due to inexplicable pain in the lower abdomen and was diagnosed with appendicitis . After the appendectomy, the feeling of abdominal pain was not relieved at all. Half a year ago, Mr. Zhang went to another hospital for treatment and was diagnosed with intestinal adhesion . After undergoing laparoscopic intestinal adhesion loosening surgery, the symptoms of abdominal pain still did not relieve.
The disheartened Mr. Zhang came to Professor Li Yaming, director of the Department of Spinal Trauma Surgery (Department III) of Wuhan University People's Hospital for treatment with the last glimmer of hope.
"This is not an abdominal disease, it is highly suspected that it is intra-spinal tumor ." Li Yaming conducted a detailed physical examination for him. After ruled out the abdominal disease, he judged that the spinal cord nerve damage may be caused by spinal-related diseases, which in turn caused abdominal pain. The subsequent examination results showed that there was a huge extramedullary intradural tumor in the spinal canal segments of the thoracic 11-12, accounting for more than 90% of the spinal canal volume, and the spinal cord was obviously compressed and biased to one side.
is located according to the body surface of nervous system . The spinal cord dermal branches of the thoracic segments 10-12 control the area between the umbilical plane and the pubic joint plane. Li Yaming judged that the root pain caused by spinal cord in this segment spinal cord is the "culprit" of the patient's abdominal pain. Common types of intra-spinal tumors are schwannoma , schwannoma and neurofibroma. Combined with various examinations such as patient's medical history and imaging pathology, it is more likely that the tumor in the patient's spinal canal is schwannoma.
"When the third operation is performed, both the patient and the doctor, the psychological pressure is very high, but if the tumor is not removed in time, the patient may experience both lower limb paralysis at any time, which will delay life." After a group discussion, the expert group decided to face the difficulties and decided to perform a difficult "posterior approach thoracic laminectomy decompression + tumor removal + pedicle screw internal fixation" for the patient to completely remove the tumor.
tumor image.
surgery was performed on October 20. After the operation, Mr. Zhang's abdominal pain completely disappeared, and the results of the disease examination also confirmed the preoperative diagnosis of the expert team.
Li Yaming introduced that intra-spinal schwannomas have a high incidence among middle-aged and young people, with no obvious gender differences. Nearly one-third of benign tumors in the spinal canal are schwannomas. Different segments of schwannoma in the spinal canal will lead to different symptoms: If schwannoma is located in the cervical vertebra, it will mostly cause pain in the upper limbs; if it is located in the lumbar segment, it will mostly cause pain in the lower limbs. "If the treatment is not done in time, as the tumor increases and the compression of the spinal cord nerves, patients may experience limb paralysis and sensory disorders in the short term, which seriously affects the quality of life and the treatment effect of later surgery."
Li Yaming reminds that the early symptoms of intra-spinal schwannoma are not obvious and are prone to missed diagnosis; cases with abdominal pain as the main clinical symptoms are relatively rare and easy to misdiagnose; the first department of patients with abdominal pain is generally general surgery or gastrointestinal surgery, not orthopedics, which increases the difficulty of diagnosis and treatment for clinicians. "After searching the literature, there was only one Spanish man around the world who developed abdominal pain symptoms after suffering from this disease and was eventually diagnosed with an intra-spinal schwannoma. Therefore, it is extremely important to seek a professional doctor's diagnosis."
Li Yaming suggested that when a patient has abdominal symptoms and there is no obvious abnormality in the corresponding abdominal examination, clinicians can consider the possibility of the patient suffering from intra-spinal occupancy, especially the schwannoma, and promptly consult multi-disciplinary questions to clarify the cause and treat the disease symptomatically to avoid delaying the condition. (Changjiang Daily reporter Li Qing, correspondent Yang Cen, Shang Xiaobin)
[Editor: Yu Lina]
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