Osteitis ischii and pubis following abdominoperineal resection for carcinoma of the rectum; case report.

Abstract

Leucutia, who reviewed the literature of osteitis pubis up to June 1950, listed 116 authenticated cases and added 4 of his own. In some of the earlier reports on osteitis pubis, frank osteomyelitis of the pelvis had been erroneously included. Among all the cases reviewed by Leucutia, only one, that of Abrams, Sedlezky, and Stearns, followed abdominoperineal resection for carcinoma of the rectum. Because of the rarity of this complication of rectal resection for carcinoma, we are reporting the following case. It is of interest, also, in that radiation therapy effected a complete cure. The clinical importance of osteitis pubis lies mainly in its correct differentiation from metastatic cancer, since it offers an entirely different prognosis, being self-limited. Case Report H. K., a 42-year-old male, was admitted to the Jewish Sanitarium and Hospital for Chronic Diseases on Jan. 22, 1952. He had diabetes of five years duration, which had been controlled by diet, with the addition of insulin in 1951. In 1949 he had undergone a hemorrhoidectomy. One year later, Nov. 12, 1950, he was admitted to a local hospital with a history of practically continuous diarrhea and lower abdominal pain since the operation. Inspection of the rectum disclosed small internal hemorrhoids. A gastrointestinal series at that time led to a clinical diagnosis of diverticulitis (Nov. 22, 1950). No barium enema study was done. Another physician was consulted and a second gastrointestinal series was followed by complete obstruction. The patient was then admitted to a different local hospital, where a cecostomy was performed on May 21, 1951. The obstruction was found to be due to a lesion within the rectum, which proved on biopsy to be an adenocarcinoma, Grade 2. An abdominoperineal resection was done on June 12. Findings were as follows: “carcinoma of the rectosigmoid; no evidence of remote metastases; some swollen nodes in the mesocolon but not characteristically malignant.” The postoperative course was uneventful. The cecostomy was closed on June 30, and the patient was discharged on July 30 with a permanent colostomy. Following surgery he felt weak and did not return to work until December. During the month of December, the patient had slight pains in his legs, which became disabling when he attempted to work. The pain started on the left side and was less severe on the right. After roentgenographic studies of the pelvis, a private physician made a diagnosis of metastatic carcinoma. There was no elevation of temperature or pulse at any time. On admission to the Jewish Sanitarium and Hospital for Chronic Diseases, the patient had severe pain in the inguinal region, groin, and hips, which prevented him from walking or sitting and required large doses of opiates for relief. There was, however, good power in the lower extremities. The reflexes were intact. Temperature was normal. Blood pressure was 120/70; pulse 84.