J Korean Soc Spine Surg.  2009 Sep;16(3):222-227. 10.4184/jkss.2009.16.3.222.

The Rectal Fistula Complicating an L5-S1 Postoperative Spondylodiscitis: A Case Report

• Lee SH
• Seo EM
• Choi SI
• Kim KT

• KMID: 2003118
• DOI: http://doi.org/10.4184/jkss.2009.16.3.222

Abstract

To our knowledge, there are no reported cases of rectal fistula complicating spondylodiscitis. We report the first case of a rectal fistula communicating with the site of postoperative recurrent spondylodiscitis. A-59-year-old female had recurrent spondylodiscitis after an open discectomy for L5-S1 eight years earlier. She underwent three operations including two anterior lumbar interbody fusion procedures after an open discectomy. Radiographic studies revealed severe bony destruction with abscess collection within the L5-S1 intervertebral disc space with fistula formation into the rectum. The fistula was confirmed by a Barium enema colon study and sigmoidscopy. The patient underwent a staged operation consisting of a rectosigmoid colon resection, anterior interbody fusion and posterior instrumented fusion. Rectum related complications were suspected in this case of recurrent spondylodiscitis.

Keyword

Spondylodiscitis; Rectal fistula

MeSH Terms

Abscess
Barium
Colon
Discitis
Diskectomy
Enema
Female
Fistula
Humans
Intervertebral Disc
Rectal Fistula
Rectum
Barium

Figure

• 

  Fig. 1. Plain radiographs of the lumbar spine showing a narrowed disc space at L5-S1 with endplate destruction, reactive sclerosis of the vertebral bodies.

• 

  Fig. 2. (A, C) T2-weighted and (B, D) T1-weighted contrast enhanced MR sagittal images showing an abscess in L5-S1 disc space, extending into the rectum (arrows) and the epidural space (arrow heads).

• 

  Fig. 3. Barium enema colon study showing dye leakage into L5-S1 disc space.

• 

  Fig. 4. Photographs showing two orifices at the 15cm upper portion from the anal verge on sigmoidscopy.

• 

  Fig. 5. Intraoperative photographs showing resection and reanastomosis procedure of the rectum (A) and rectal specimen with fistula (B).

• 

  Fig. 6. Radiographs of lumbar spine showing posterior instrumentation and posterolateral fusion at L4-5-S1 vertebra to restore the mechanical integrity of the spinal motion segments.

• 

  Fig. 7. CT scans showing incomplete bony union of autogenous fibula bone graft at L5-S1 (A) but bony union of L4-5-S1 posterolateral fusion (B,C).

Reference

1). Twyman RS, Robertson P, Thomas MG. Meningitis complicating spinal surgery. Spine. 1996; 21:763–765.

2). Kapoor B, Toms A, Hooper P, Fraser AM, Cox CW. Infective lumbar discitis following laparoscopic sacro-colpopexy. J R Coll Surg Edinb. 2002; 24:709–710.

3). Schulze CJ, Mayer HM. Exogenous lumbar spondylodici-tis following a stabwound injury and vertebral fracture. A case report and review of literature. Eur Spine J. 1995; 4:357–359.

4). Gottwald M, Andress HJ, Schinkel C. Unspecific spoondylodiscitis following anastomotic leakage after rectal resection. Zentrabli Chir. 2003; 128:337–340.

5). Brown EM, Pople IK, de louvois J, et al. .:. Spine update: Prevention of postoperative infection in patient undergoing spinal surgery. Spine. 2004; 29:938–945.

6). Capen DA, Calderone RR, Green A. Perioperative risk factors for wound infections after lower back fusion. Orthop Clin North Am. 1996; 27:83–86.

7). Klevens RM, Edwards JR, Tenover FC, McDonald LC, Horan T, Gaynes R. Changes in the epidemiology of methicillin-resistant aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis. 2006; 42:389–391.

8). Al-Nammari SS, Lucas JD, Lam KS. Hematogenous methicillin-resistant Staphylococcus aureus spondylodiscitis. Spine. 2007; 32:2480–2486.

9). Stevens QE, Seibly JM, Chen YH, Dickerman RD, Noel J, Kattner KA. Reactivation of dormant lumbar methicillin-resistant Staphylococcus aureus osteomyelitis after 12 years. J Clin Neurosci. 2007; 14:585–589.

10). Mann S, Schu¨tze M, Sola S, Piek J. Nonspecific pyogenic spondylodiscitis: clinical manifestation, surgical treatment, and outcome in 24 patients. Neurosurg Focus. 2004; 17:3.