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Archives de pédiatrie
Volume 22, n° 12
pages 1298-1301 (décembre 2015)
Doi : 10.1016/j.arcped.2015.09.001
Received : 1 October 2014 ;  accepted : 12 September 2015
Quelle conduite devant une fossette sacrée ?
Sacral dimple: What form of management is best?
 

M. Zanello, M. Zerah, F. Di Rocco
 Service de neurochirurgie pédiatrique, hôpital Necker–Enfants Malades, 149, rue de Sèvres, 75015 Paris, France 

Auteur correspondant.
Résumé

La conduite à tenir face à une dépression sacrée doit être systématisée. La découverte d’une fossette mesurant moins de 5mm, éloignée de moins de 25mm de l’anus sur la ligne médiane, sans autre anomalie cutanée ne justifie aucun examen complémentaire et permet de rassurer les parents. En revanche, toute dépression cutanée dans la région sacro-lombaire ne respectant pas ces critères doit être considérée comme un dysraphisme occulte jusqu’à preuve du contraire. Une échographie médullaire et une consultation auprès d’un neurochirurgien pédiatre sont à prescrire au moindre doute. Le sinus dermique est le principal diagnostic différentiel, il est de bon pronostic si la prise en charge est précoce mais le risque de handicap définitif majeur est important s’il est négligé ou diagnostiqué avec retard.

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Summary

A sacral dimple measuring less than 5mm, within 25mm of the anus on the median line, with no other cutaneous anomaly, does not require any complementary examination. Parents can be reassured. However, any cutaneous depression in the sacrolumbar region not respecting these criteria must be considered as an occult dysraphism until proved otherwise. A medullary ultrasound examination and a consultation with a specialist (pediatric neurosurgeon) are necessary. The dermic sinus is the main differential diagnosis, with favorable outcome in case of early treatment before any infectious complication arises. Conversely, the risk of permanent sequelae is high if neglected or in case of late diagnosis.

The full text of this article is available in PDF format.


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