Abstract
BackgroundSpinal epidural abscess is a rare condition with high morbidity and mortality, for which a delay in diagnosis and treatment can lead to irreversible neurologic deficit or even death. Although patients with spinal epidural abscess have systemic predisposing immunocompromised conditions, spinal intervention, or trauma, this condition has been reported as a result of perforation or fistulization arising from inflammatory bowel disease. We describe herein a rare case of spinal epidural abscess as a complication of ileal pouch anal anastomosis.Case presentationA 37-year-old man who had previously undergone restorative proctocolectomy and ileal pouch anal anastomosis for ulcerative colitis presented with complaints of persistent low-grade fever and lumbago with unusual sensation in the lower legs. After evaluation by Gastrografin contrast radiography, computed tomography, and magnetic resonance imaging, he was diagnosed with a spinal epidural abscess extending from L5 to S1. In addition, the abscess communicated with the ileal pouch. He underwent surgical drainage of the abscess, excision of the fistula, and defunctioning ileostomy. Although a second operation for drainage was required for residual presacral abscess, there was no sign of recurrence of the spinal epidural abscess. He eventually was able to close his stoma.ConclusionsAlthough spinal epidural abscess is a rare complication, one should take this condition into account when patients complain of back pain or neurologic symptoms of the lower extremities, given the possibility of fistulous communication between the ileal pouch and spine.
Highlights
Spinal epidural abscess is a rare condition with high morbidity and mortality, for which a delay in diagnosis and treatment can lead to irreversible neurologic deficit or even death
Conclusions: spinal epidural abscess is a rare complication, one should take this condition into account when patients complain of back pain or neurologic symptoms of the lower extremities, given the possibility of fistulous communication between the ileal pouch and spine
Spinal epidural abscess is an uncommon disease that accounts for 0.2–1.2 cases per 10,000 hospital admissions, with a relatively high rate of associated morbidity and mortality [2, 4, 5]
Summary
Spinal epidural abscess is an uncommon disease that accounts for 0.2–1.2 cases per 10,000 hospital admissions, with a relatively high rate of associated morbidity and mortality [2, 4, 5]. One case of ulcerative colitis with IPAA-associated spinal epidural abscess has been previously reported. In this patient reported by Brown et al [14], spinal epidural abscess was precisely diagnosed and immediate laminectomy was performed, the infectious source was not detected. We precisely diagnosed a spinal epidural abscess resulting from an ileal pouch spinal fistula, and assessed the neurologic impairment as stage 2 disease. Pouch-related spinal epidural abscess is an extremely rare complication of ulcerative colitis after IPAA, one should include this condition in the differential diagnosis when encountering patients with systemic inflammation and neurologic impairment. Long-term results of salvage surgery for septic complications after restorative proctocolectomy: does fecal diversion improve outcome? Dis Colon Rectum. 2003;46(10):1339–44
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