A 66-year-old man suddenly fell into a state of shock on his way back to his room after emergency coronary angiography and intracoronary thrombolysis for acute myocardial infarction. Both echocardiography and pericardiocentesis suggeted a diagnosis of cardiac rupture. The patient was transferred to an operating room with a percutaneous cardiopulmonary support system (PCPS) and intraaortic balloon pumping. Following thoracotomy and release of cardiac tamponade, blow out rupture of the left ventricular free wall was detected. The rupture was repaired using triple mattress sutures by reinforcing with felt pledgets. An infarctectomy was not added and cardiopulmonary bypass was not used. Postoperative recovery of cardiac function was satisfactory and the left ventricular ejection fraction after 2 months was 35%. PCPS and consecutive surgical therapy are effective for the treatment of blow out rupture of the left ventricular free wall.

OBJECTIVETo characterize the symptoms of neurogenic intrapelvic syndrome and the pathogenic mechanisms.

METHODSA total of 537 patients with neurogenic intrapelvic syndrome were treated in the Takano Hospital between 2001 and 2005. Clinical data were analyzed retrospectively.

RESULTSThe mean age was 58.5 years old. There were 205 males and 332 females. There were 80 patients(14.9%) who presented with only one symptom with anorectal pain being the most common one (43.8%, 35/80). One hundred and fifty-six(29.1%) patients had two symptoms with anorectal pain and difficult evacuation being the most common combination (26.3%, 41/156). There were 144 patients (26.8%) complained of 3 symptoms and the most common combination was anorectal pain, difficult evacuation, and abdominal discomfort (30.0%, 43/144). A combination of 4 symptoms was reported in 105 patients(19.6%) with the combination of anorectal pain, incontinence, abdominal discomfort, and lumbar discomfort being the most often(65.7%, 69/105). In addition, there were 52 patients(9.7%) who had above 5 symptoms simultaneously. The frequencies of the 5 symptoms were 73.6% for anorectal pain, 27.9% for incontinence, 69.6% for difficult evacuation, 55.3% for abdominal discomfort, and 53.6% for lumbar discomfort.

CONCLUSIONSSymptomatology of neurogenic intrapelvic syndrome is complicated. The pathogenic mechanism may be related to concurrent dysfunction of sacral nerve and pelvic splanchnic nerve.

Encopresis ; etiology ; Female ; Humans ; Male ; Middle Aged ; Pelvic Pain ; etiology ; Retrospective Studies ; Syndrome