Carter Marguerite, Meshkat Babek, El-Masry Sherif
Department of Surgery, UHL, Limerick, Ireland.
Department of Surgery, Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland.
BMJ Case Rep. 2014 Dec 19;2014:bcr2014207446. doi: 10.1136/bcr-2014-207446.
A 62-year-old man presented via the emergency department with a 1-week history of back pain, on a background of non-insulin-dependent diabetes mellitus and rectal carcinoma for which he had undergone abdominoperineal resection, chemotherapy and radiotherapy. He exhibited signs of sepsis, midline lumbar spine tenderness and reduced hip flexion. CT of the abdomen and pelvis showed a presacral collection contiguous with the tip of the appendix, and MRI lumbar spine revealed abscess invation into the epidural space extending to T9. He underwent a laparotomy with washout of the presacral abscess and appendicectomy and prolonged course intravenous antibiotic therapy. At 3 months after initial presentation he had made a full clinical recovery with progressive radiological resolution of the epidural abscess. The objective of the case report is to highlight a unique and clinically significant complication of a very common pathology (appendicitis) and to briefly discuss other intra-abdominal sources of epidural abscess.
一名62岁男性通过急诊科就诊，有1周背痛病史，既往有非胰岛素依赖型糖尿病和直肠癌病史，曾接受腹会阴切除术、化疗和放疗。他表现出脓毒症体征、腰椎中线压痛和髋关节屈曲受限。腹部和盆腔CT显示骶前积液与阑尾尖端相连，腰椎MRI显示脓肿侵入硬膜外间隙并延伸至T9。他接受了剖腹手术，冲洗骶前脓肿并进行阑尾切除术，以及长时间的静脉抗生素治疗。首次就诊3个月后，他临床完全康复，硬膜外脓肿在影像学上逐渐消退。本病例报告的目的是强调一种非常常见的病理情况（阑尾炎）的独特且具有临床意义的并发症，并简要讨论硬膜外脓肿的其他腹腔内来源。
