Gastric ulceration causing thoracic spondylodiscitis: a first case of a rare complication post oesophagectomy.

M Townsend,D Nehra,D Panchalingam,H Kaderbhai,C Bailey,A Keane,K Burney,R Karthigan

doi:10.1259/bjrcr.20170074

Abstract

We report the case of an 84-year-old male, who presented with septicaemia, abdominal and back pain. The patient had a background of oesophageal carcinoma and had undergone previous oesophagectomy and gastric pull-up operation 10 years ago. A computerised topography scan demonstrated a probable gastro-vertebral communication with a destructive process at the T8/T9 vertebral level. Further evaluation with MRI clearly showed the tract between the two structures and confirmed the diagnosis of spondylodiscitis at the adjacent spinal level. The patient was resuscitated, treated with intravenous antibiotics and kept nil by mouth. A subsequent gastroscopy demonstrated an eroding gastric ulcer at the enteric opening of the tract between the tubal stomach and the spinal column. The diagnosis was discussed with the patient, his family and the surgical multidisciplinary team. Given the extent of disease and his multiple medical co-morbidities, the decision was made for conservative management and symptom control. This is the first case of a gastro-vertebral communication causing spondylodiscitis to be described in the literature.

Highlights

We report the case of an 84-year-old male, who presented with septicaemia, abdominal and back pain
Initial plain film imaging with erect chest X-ray in the emergency department demonstrates this gastric pull-up (Figure 1) Following early resuscitation with oxygen, intravenous fluids and antibiotics, the patient underwent a CT scan
This demonstrated a diverticulum seen arising from the postero medial wall of the pulled stomach with an adjacent aggressive destructive process of the T8 and T9 intervertebral discs (Figure 2) These features were suspicious for a gastro-vertebral communication with resulting spondylodiscitis

Summary

Case report

Gastric ulceration causing thoracic spondylodiscitis: a first case of a rare complication post oesophagectomy. M Townsend, MBChB, R Karthigan, MBBS, H Kaderbhai, MBBS, C Bailey, MBChB, D Panchalingam, MBBS, A Keane, MBBS, D Nehra, MBBS and K Burney, MBBS Epsom and St Helier’s NHS Trust, Carshalton, UK

Clinical presentation

Findings

Learning points