Abstract
BackgroundPyogenic spondylodiscitis is an extremely rare complication of esophagectomy for esophageal cancer.Case presentationA 70-year-old Japanese man, with a previous medical history of type 2 diabetes mellitus, coronary artery disease, and laryngeal cancer, received neoadjuvant chemotherapy and underwent thoracoscopic esophagectomy with gastric tube reconstruction for advanced esophageal cancer. Cervical esophagogastrostomy with circular-stapled end-to-side anastomosis was performed. However, partial necrosis in the gastric tube developed to form refractory anastomotic fistula. Two months after the initial surgery, debridement and free jejunal transfer reconstruction with the pectoralis major muscle flap were performed. Although the postoperative course of the second surgery was uneventful, the patient complained of severe lower back pain and fever. The patient was diagnosed with pyogenic spondylodiscitis according to the results of the magnetic resonance imaging. Enterobacter cloacae were isolated from the arterial blood culture. Sensitive antibiotics were administered continuously, and the patient required to use a lumbar corset for 2 months. Subsequently, his physiological signs and symptoms had completely disappeared.ConclusionTo the best of our knowledge, this case study is the first study that reported pyogenic spondylodiscitis of the lumbar spine, a complication of cervical anastomotic fistula after surgery for advanced esophageal cancer.
Highlights
Pyogenic spondylodiscitis is a rare infection of the spine caused by the hematogenous spread of infection or direct inoculation of pathogens from the adjacent purulent focus
Case report A 70-year-old Japanese man who complained of dysphagia was admitted to our hospital. He had a medical history of using medications for type 2 diabetes mellitus, percutaneous coronary intervention for coronary artery disease, and radiotherapy for laryngeal cancer
Patients presented with cervical esophagogastric anastomosis after surgery for esophageal cancer are at the highest risk for ischemia and fistula formation because cervical anastomosis is the farthest from the right gastric and gastroepiploic arteries, which nourish the gastric tube
Summary
Purulent spondylitis after esophagectomy is an extremely rare complication that can lead to catastrophic sequelae, such as quadriplegia and subsequent epidural abscess. All esophageal surgeons should be knowledgeable of the disease to facilitate early detection and adequate treatment. When such patients develop recurrent back pain postoperatively, the diagnosis of pyogenic spondylitis must be considered
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