Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco.
Surg Infect (Larchmt). 2009 Dec;10(6):549-51. doi: 10.1089/sur.2008.048.
Deep pelvic abscess is a well-known infective complication in gynecologic practice. However, sacral osteomyelitis has been reported rarely. We describe sacral infection presenting three years after abdominal hysterectomy and point out the difficulty in management.
Case report and review of the pertinent literature.
A 46-year-old woman who had undergone abdominal hysterectomy three years before presented with an 8-month history of abdominopelvic pain recently intensifying in the sitting position without fever. Gynecologic, urinary, and rectal examination did not yield positive findings. An abdominopelvic computed tomography (CT) scan was normal except for sacral osteolysis. A neoplasm was suspected, but magnetic resonance imaging revealed an S2-S4 cystic collection with presacral extension. Neurologic examination did not show any focal deficits. A posterior CT-guided biopsy-aspiration yielded purulent fluid. Pathologic examination revealed inflammatory granulations without any malignant tumor. Abscess cultures grew three microorganisms. The patient's symptoms resolved completely after 3 months of antibiotic therapy.
Sacral osteomyelitis has not been reported previously after abdominal hysterectomy. Early diagnosis was made difficult by the absence of neurologic findings. Such postoperative infection should be considered after pelvic surgery. Minimally invasive needle aspiration may confirm the diagnosis and reduce the necessary extent of surgical intervention.
深部骨盆脓肿是妇科实践中众所周知的感染性并发症。然而，骶骨骨髓炎的报道很少。我们描述了一例腹部子宫切除术后三年出现的骶骨感染，并指出其治疗难度。
病例报告并复习相关文献。
一名 46 岁女性，在 3 年前接受了腹部子宫切除术，最近出现了 8 个月的腹痛和骨盆痛，在坐位时加重，无发热。妇科、泌尿科和直肠检查均未发现阳性发现。腹部盆腔 CT 扫描除了骶骨溶骨性病变外正常。怀疑为肿瘤，但磁共振成像显示 S2-S4 囊性积液，伴有直肠前延伸。神经检查未发现任何局灶性缺损。后路 CT 引导下活检抽吸术获得脓性液体。病理检查显示无任何恶性肿瘤的炎性肉芽组织。脓肿培养出三种微生物。经过 3 个月的抗生素治疗，患者的症状完全缓解。
腹部子宫切除术后骶骨骨髓炎以前未有报道。由于缺乏神经学发现，早期诊断较为困难。此类术后感染应在盆腔手术后考虑。微创性针吸术可明确诊断，并减少手术干预的必要范围。
