A case of coccyodynia: removal of coccyx, recovery.

Boston Medical and Surgical Journal

1890, Volume 123, number 13, Pages 300-301.

Post, A, Goldthwait, JE.

Boston City Hospital

Mrs. A., a boarding-house keeper, thirty-one years of age, has had, beginning a year ago, quite constant pain in the back, running down to the "tip of the spine". The pain has increased in severity and for the past five months she has been unable to sit squarely, being obliged to rest entirely upon one buttock. Of late the pain has extended down the legs. Defecation is quite painful, and for a few weeks micturition has been very frequent. The catamenia are regular.

The patient's previous health has been good, and she is ignorant of any cause for the present symptoms. She had a slight fall eight years ago striking upon the buttock, but suffered no inconvenience from it. She has had four children, the youngest being three years of age, and, as far as can be made out, the labors were normal.

Examination revealed great tenderness in the region of the coccyx, rendering a complete examination impossible.

After treatment by rest in bed, laxatives, etc., for ten days with no improvement, the patient was etherized and a thorough examination made for the first time. The lower half of the coccyx projected inwards, toward the rectum, at right angles to its normal position, and was freely movable. Aside from this nothing abnormal was found.

The operation was immediately done. An incision, three inches long, was made just back of the anus, in the cleft between the buttocks and through this the lower portion of the coccyx was removed. A fracture was found which extended transversely across the bone at the point of mobility.

The wound was irrigated with a solution of corrosive sublimate (1-3,000), and tightly closed with silk sutures. A gauze dressing moist in the corrosive solution (1-3,000) was applied.

The recovery was rapid and uneventful. The wound healed by first intention.

On the fifth day after operation the bowels moved with much less pain than formerly.

Ninth Day. - Has had more or less pain for a few days, but upon removal of the stitches this was entirely, relieved.

Sixteenth Day. - Is up to-day and is able to sit squarely, a thing she has not been able to do for a long time.

Nineteenth Day - Has been up and about the ward for several days. Defecation is regular and not painful. Micturition is much less frequent. Says she feels twenty years younger. Patient was discharged on this day.

A short time after leaving the hospital she was again married, and, so far as her sensations about the coccyx are concerned, has been well.

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