慢性尾骨痛併發上腸繫膜動脈症候群：病例報告

Chronic Coccygodynia Complicated with Superior Mesenteric Artery Syndrome: A Case Report

10.30059/JTRS.200510.0007

陳凱華(Kai-Hua Chen)；許宏志(Hung-Chih Hsu)；林智容(Chih-Jung Lin)

尾骨痛coccygodynia ； 上腸繫膜動脈症候群superior mesenteric artery syndrome ； coccygodynia ； superior mesenteric artery syndrome

中華推拿與現代康復科學雜誌

2卷1期（2005 / 10 / 01）

46 - 56

繁體中文

尾骨痛(coccygodynia)為復健科門診常見疼痛症候群，其疼痛原因可來自於機械性、神經性或其他不明因素所引起。機械性因素包括尾骨挫傷、脫位(luxation)、過動(hypermobility)或腫瘤等，神經性因素包括來自腰椎、薦椎神經的反射痛或自主神經失調。在治療上，輕微者可以止痛劑、中空坐墊和接受物理治療即可緩解疼痛，嚴重時則可能需接受手術治療。若治療不完全，亦可能導致嚴重併發症。 本病例為一年青女性，因車禍造成尾骨挫傷，由於治療的不完全，發展成慢性尾骨痛。除了尾骨底部疼痛外，消化功能也漸漸受到影響：由排便困難、進食後嘔吐、體重急速下降，甚至併發罕見的上腸繫膜動脈症候群(superior mesenteric artery syndrome, SMAS)。病患的尾骨底疼痛和消化功能於局部類固醇注射治療後也相繼改善。 上腸繫膜動脈症候群在臨床上非常罕見，其發生率只有0.1-0.33%，由尾骨痛引起的病例則未曾被報告過。因此，藉本文回顧相關文獻，了解尾骨痛和上腸繫膜動脈症候群的原因、診斷、治療方法及兩者的關連性，提供臨床醫師作參考。

Coccygodynia is a common painful syndrome in rehabilitation clinics, which can have mechanical, neurogenic or unknown etiologies. Mechanical causes include coccygeal contusion, luxation, hypermobility or tumor. Neurogenic causes include referred pain from lumbar or sacral roots, or dysfunction of the autonomic nervous system. Mild coccygeal pain can be managed using analgesics, a donut pillow support and physiotherapy, while surgery may be necessary in serious cases. Failure to treat can lead to severe complications. Herein, we describe the case involving a young girl who sustained a coccygeal contusion as a result of a traffic accident. Incomplete treatment spawned chronic coccygodynia. Gastrointestinal involvement in the form of constipation, postprandial vomiting, and rapid body weight loss was also evident, and preluded the development of superior mesenteric artery syndrome (SMAS). Focal treatment with steroid. injection progressively alleviated the coccygeal pain and gastrointestinal dysfunction. SMAS is a rare clinical disorder with an incidence rate of 0.1% to 0.33%. Its association with coccygodynia has not hitherto been reported. The present article reviews the causes, diagnosis, management and the relationship between SMAS and coccygodynia.

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