Faecal incontinence as presentation of an ependymomas of the spinal cord
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Case report
Faecal incontinence as presentation of an ependymomas of the spinal cord Santhini Jeyarajah*, Andrew King and Savvas Papagrigoriadis Address: Colorectal and Histology Department, Kings College Hospital, Denmark Hill, London SE5 9RS, UK Email: Santhini Jeyarajah* - [email protected]; Andrew King - [email protected]; Savvas Papagrigoriadis - [email protected] * Corresponding author
Published: 25 September 2007 World Journal of Surgical Oncology 2007, 5:107
doi:10.1186/1477-7819-5-107
Received: 22 May 2007 Accepted: 25 September 2007
This article is available from: http://www.wjso.com/content/5/1/107 © 2007 Jeyarajah et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Spinal tumours and ependymomas in particular are rare causes of cauda equina syndrome that present with faecal incontinence. Case presentation: We present a case of a 45 year old gentleman who presents to a colorectal clinic with incontinence. We then present a review of ependymomas with particular reference to the symptoms they cause as well a review of the neurophysiology of faecal continence. Conclusion: Suspicion for non-colonic causes for faecal incontinence should arise when there is absence of other etiologic factors. Establishment of the diagnosis of spinal tumours is with neurological examination and MRI spine.
Background Lower motor neuron symptoms such as lower limb weakness, loss of sensation, sphincter and erectile dysfunction can be caused by disruption of the cauda equina by a spinal tumour (cauda equine syndrome). The symptom of faecal incontinence due to primary spinal tumours however is rare. Is has been reported in lumbar schwannoma of the cauda equina, [1] lumbosacral intrapsinal lipomas [2,3] and metastatic spinal deposits [4]. Ependymomas however are not frequently associated with this symptom. Here we present a case where this is seen and explore the features usually associated with this condition.
Case presentation A 45 year old gentleman is referred to a colorectal clinic with diarrhoea and faecal incontinence for 2 months. He has also suffered with progressively worsening urinary symptoms: hesitancy, frequency and nocturia, poor stream and sensation of incomplete emptying and possi-
ble intermittent retention, with urge incontinence over 2 years. Previous review by Urologists revealed no abnormality on cystoscopy, X-ray KUB or renal ultrasound and a diagnosis of prostatitis was made. There was no history of pain, lower limb neurological symptoms and he had normal erectile function. There was no history of diabetes, multiple sclerosis or other neurological disease. On clinical examination, resting and squeeze anal tone were reduced. Perianal sensation was intact. Colonoscopy was requested which revealed
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