Paraspinal and Extensive Epidural Abscess: The Great Masqueraders of Abdominal Pain.

Andrew Chu,Uday Shankar,Thu Thu Aung

doi:10.1155/2015/103624

Abstract

Paraspinal and epidural abscesses are rare conditions often diagnosed later in the disease process that can have significant morbidity and mortality. Predisposing risk factors include diabetes, human immunodeficiency virus, intravenous drug abuse, and previous history of spinal surgery or injection. They can threaten the spinal cord by compressive effect, leading to sensory motor deficits and ultimately paralysis and death. Diagnosis may be a challenge due to the delayed presentation of nonspecific back pain or radicular pain such as chest pain or abdominal pain. We present a rare case on a patient with periumbilical pain, constipation, and urinary retention who was ultimately diagnosed with a paraspinal abscess extending into the epidural space from T1 to S2. He underwent decompressive laminectomy with incision and drainage of the abscesses. The patient made an excellent recovery postoperatively, and repeat magnetic resonance imaging at six weeks showed resolution of the abscess.

Highlights

Paraspinal and epidural abscesses are rare medical emergencies, estimated to be about 0.2–1.2 cases per 10,000 hospital admissions [1]
We present a rare case of a young man who exhibited acute onset of periumbilical pain, constipation, and urinary retention
Paraspinal and epidural abscesses are rare conditions that can often be misdiagnosed unless physicians have high index of suspicion

Summary

Introduction

Paraspinal and epidural abscesses are rare medical emergencies, estimated to be about 0.2–1.2 cases per 10,000 hospital admissions [1]. There have been only a few published case reports in medical literature regarding abdominal pain as the main presenting feature of epidural abscesses [2, 5–8]. There has not been a case of paraspinal and extensive epidural abscess presenting with a vague abdominal pain. A paraspinal abscess extending into epidural space from T1 to S2 was subsequently found. This case serves to emphasize a high index of clinical suspicion for paraspinal and epidural abscess in someone who is presenting with vague abdominal pain in the absence of intra-abdominal pathology

Case Presentation

Findings

Discussion