Taylor William E, Wolff Bruce G, Pemberton John H, Yaszemski Michael J
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Dis Colon Rectum. 2006 Jun;49(6):913-8. doi: 10.1007/s10350-006-0524-3.
This study describes an institutional experience with sacral osteomyelitis after proctocolectomy and ileal pouch-anal anastomosis.
A total of 2,375 patients underwent ileal pouch-anal anastomosis at the Mayo Clinic between January 1981 and January 2002. In addition, we have served as a tertiary referral base for patients with complications after ileal pouch-anal anastomosis performed at other institutions. Review of our ileal pouch-anal anastomosis prospective database and directed search of the central pathology, microbiology, radiology, and surgical records at the Mayo Clinic was performed using these keywords: osteomyelitis, ileal pouch-anal anastomosis, inflammatory bowel disease, chronic ulcerative colitis, and Crohn's disease.
Two of 2,375 patients (0.08 percent) with ileal pouch-anal anastomosis performed at our institution have had sacral osteomyelitis. In addition, two patients have been referred for continuing care after construction of an ileal pouch-anal anastomosis and diagnosis of sacral osteomyelitis at another institution. Two of the four patients maintained normal pouch function after sacral debridement and a period of fecal stream diversion. One patient remains diverted with resolved sacral osteomyelitis after debridement. The last patient died from squamous-cell cancer involving the sacrum.
Sacral osteomyelitis is a rare and heretofore unreported complication of ileal pouch-anal anastomosis. Conservative measures using antibiotics alone proved unsuccessful, and delaying definitive management may have contributed to the degeneration of a chronic sacral abscess into squamous-cell cancer. With more aggressive treatment comprising sacral debridement, long-term antibiotics, and fecal diversion, pouch function can potentially be preserved.
本研究描述了直肠结肠切除术后回肠储袋肛管吻合术并发骶骨骨髓炎的机构经验。
1981年1月至2002年1月期间，共有2375例患者在梅奥诊所接受了回肠储袋肛管吻合术。此外，我们还作为其他机构行回肠储袋肛管吻合术并发症患者的三级转诊基地。使用以下关键词对我们的回肠储袋肛管吻合术前瞻性数据库进行回顾，并直接检索梅奥诊所的中央病理学、微生物学、放射学和手术记录：骨髓炎、回肠储袋肛管吻合术、炎症性肠病、慢性溃疡性结肠炎和克罗恩病。
在我们机构接受回肠储袋肛管吻合术的2375例患者中有2例（0.08%）发生了骶骨骨髓炎。此外，有2例患者在其他机构行回肠储袋肛管吻合术并诊断为骶骨骨髓炎后被转诊来继续治疗。4例患者中有2例在骶骨清创和一段时间的粪便转流后保持了储袋功能正常。1例患者在清创后粪便转流，骶骨骨髓炎已痊愈。最后1例患者死于累及骶骨的鳞状细胞癌。
骶骨骨髓炎是回肠储袋肛管吻合术一种罕见且此前未报告的并发症。单独使用抗生素的保守措施被证明是不成功的，延迟确定性治疗可能导致慢性骶骨脓肿恶变为鳞状细胞癌。通过包括骶骨清创、长期使用抗生素和粪便转流在内的更积极治疗，储袋功能有可能得以保留。
