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U-shaped sacral fracture: an easily missed fracture with high morbidity. A report of two cases

Hussin P, Chan CY, Saw LB, Kwan MK

Emerg Med J, 2009 Sep;26(9):677-8.
PMID: 19700594 DOI: 10.1136/emj.2008.064972

U-shaped sacral fracture is a very rare injury. This injury is easily missed and the diagnosis is often delayed as it is difficult to detect on the anteroposterior view of the pelvic radiograph. It is highly unstable and neurological injury is common. Two cases of U-shaped sacral fractures are reported here in which the diagnosis was delayed resulting in the late development of cauda equina syndrome. In these two cases, full recoveries were achieved following surgical decompression. A high index of suspicion with proper clinical and radiographic assessments will decrease the incidence of missed diagnosis and prevent the occurrence of delayed neurological deficits.

Matched MeSH terms: Fecal Incontinence/etiology
Relationship of Anatomy and Function: External Anal Sphincter on Transperineal Ultrasound and Anal Incontinence

Paka C, Kamisan Atan I, Rios R, Dietz HP

Female Pelvic Med Reconstr Surg, 2016 10 27;23(4):238-243.
PMID: 27782978 DOI: 10.1097/SPV.0000000000000350

OBJECTIVE: The aim of this study was to investigate the association of the anatomic integrity of the external anal sphincter (EAS) detected on transperineal ultrasound (TPUS) with symptoms of anal incontinence (AI) as measured by St Mark's Incontinence Score (SMIS) and the visual analog scale (VAS).
METHODS: This is an observational, cross-sectional analysis of 486 women who presented to a tertiary urogynecological center between May 2013 and August 2014. They underwent a standardized interview and an examination that involved 3-dimensional/4-dimensional TPUS. The SMIS and VAS were administered if they answered positively to a question on AI. The association between defects of the EAS and symptoms of AI was evaluated using bivariate tests, as well as adjusting for pertinent covariates using multiple linear regression modeling.
RESULTS: Of the included patients, 17.1% reported AI, and 15.2% had significant EAS defects (≥4 slices) on TPUS imaging. A significant sonographic defect was diagnosed in 23% of women with AI versus 14% of those without (P = 0.033). Women with symptoms of AI were more likely to have a significant defect on TPUS (odds ratio, 1.878; 95% confidence interval, 1.05-3.37). No significant findings were seen when analyzing SMIS, its components, and VAS against sonographic EAS defects.
CONCLUSIONS: The symptom of AI is associated with significant EAS defects detected on TPUS. However, this study failed to show an association between significant EAS defects and the SMIS and VAS.

Matched MeSH terms: Fecal Incontinence/etiology*
Fulltext Neurogenic bowel management after spinal cord injury: Malaysian experience

Engkasan JP, Sudin SS

J Rehabil Med, 2013 Feb;45(2):141-4.
PMID: 23053003 DOI: 10.2340/16501977-1074

To describe the bowel programmes utilized by individuals with spinal cord injury; and to determine the association between the outcome of the bowel programmes and various interventions to facilitate defecation.

Matched MeSH terms: Fecal Incontinence/etiology
'Rapid transit' constipation in children: a possible genesis for irritable bowel syndrome

Hutson JM, Hynes MC, Kearsey I, Yik YI, Veysey DM, Tudball CF, et al.

Pediatr Surg Int, 2020 Jan;36(1):11-19.
PMID: 31673760 DOI: 10.1007/s00383-019-04587-x

Children with chronic idiopathic constipation (CIC) often end up at the surgeon when medical treatments have failed. This opinion piece discusses a recently described pattern of CIC called 'Rapid transit constipation (RTC)' first identified in 2011 as part of surgical workup. RTC was identified using a nuclear medicine gastrointestinal transit study (NMGIT or nuclear transit study) to determine the site of slowing within the bowel and to inform surgical treatment. Unexpectedly, we found that RTC occured in 29% of 1000 transit studies in a retrospective audit. Irritable bowel syndrome (IBS) occurs in 7-21% of the population, with a higher prevalence in young children and with constipation type dominating in the young. While 60% improve with time, 40% continue with symptoms. First-line therapy for IBS in adults is a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols which reduces symptoms in > 70% of patients. In children with functional gastrointestinal disorders, fructose intolerance occurs in 35-55%. Reducing fructose produced significant improvement in 77-82% of intolerant patients. In children with RTC and a positive breath test upon fructose challenge, we found that exclusion of fructose significantly improved constipation, abdominal pain, stool consistency and decreased laxative use. We hypothesise that positive breath tests and improvement of pain and bowel frequency with sugar exclusion diets in RTC suggest these children have IBS-C. These observations raise the possibility that many children with CIC could be treated by reducing fructose early in their diet and this might prevent the development of IBS in later life.

Matched MeSH terms: Fecal Incontinence/etiology
Anal sphincter trauma and anal incontinence in urogynecological patients

Guzmán Rojas RA, Kamisan Atan I, Shek KL, Dietz HP

Ultrasound Obstet Gynecol, 2015 Sep;46(3):363-6.
PMID: 25766889 DOI: 10.1002/uog.14845

To determine the prevalence of evidence of residual obstetric anal sphincter injury, to evaluate its association with anal incontinence (AI) and to establish minimal diagnostic criteria for significant (residual) external anal sphincter (EAS) trauma.

Matched MeSH terms: Fecal Incontinence/etiology*