背景:结直肠癌是最常见的诊断癌症之一,它与一些常见的症状和体征有关,如直肠出血,改变了排便习惯,腹痛,贫血,和无意的减肥。坐骨神经痛,一种使人衰弱的状况,患者在相关的腰骶神经根或坐骨神经分布的皮刀中出现感觉异常和疼痛,不被认为是其中之一。在这里,我们介绍了一例仅表现为坐骨神经痛症状的结直肠癌。
方法:一名68岁男性表现为进行性下背部疼痛,在L5/S1皮刀上向左大腿和小腿放射。怀疑有坐骨神经痛,最初接受了镇痛药的保守治疗。然而,症状进展,MRI令人惊讶地显示硬膜外脓肿。进行手术清创术,脓液培养分离出溶胆链球菌。基于胆溶菌与结直肠癌的强烈关联,这种病原体的存在促使进一步的肿瘤评估,即使没有典型的症状和体征。这项研究最终导致乙状结肠腺癌的诊断。
结论:虽然罕见,由脊髓硬膜外腔的胆溶酶感染引起的坐骨神经痛可能是结直肠癌的最初表现。内科医生应该意识到胆囊溶链球菌和结直肠癌之间的强关联。根据我们目前对这种情况的了解;建议对胆溶链球菌感染患者的隐匿性肿瘤进行彻底的系统评估。
BACKGROUND: Colorectal cancer is one of the most frequently diagnosed forms of cancer, and it is associated with several common symptoms and signs such as rectal bleeding, altered bowel habits, abdominal pain, anemia, and unintentional weight loss. Sciatica, a debilitating condition in which the patient experiences paresthesia and pain in the dermatome of associated lumbosacral nerve roots or sciatic nerve distribution, is not considered one of these. Here we present a case of colorectal cancer manifesting symptoms of sciatica alone.
METHODS: A 68-year-old male presented with progressive lower back pain radiating to his left thigh and calf over L5/S1 dermatome. Sciatica was suspected and initially underwent conservative treatment with analgesics. However, the symptoms progressed and MRI revealed an epidural abscess surprisingly. Surgical debridement was performed and pus culture isolated Streptococcus gallolyticus. Based on the strong association of S. gallolyticus with colorectal cancer, the presence of this pathogen prompted further tumor evaluation, even in the absence of the typical symptoms and signs. This investigation ultimately leads to the diagnosis of sigmoid adenocarcinoma.
CONCLUSIONS: Although rare, sciatica caused by S. gallolyticus infection of the spinal epidural space may serve as the initial presentation of colorectal cancer. Physicians should be aware of the strong association between S. gallolyticus and colorectal cancer. Based on what we currently know about the condition; a thorough systematic assessment of occult neoplasia for patients with S. gallolyticus infection is recommended.