Department of General Surgery, The Northern Hospital, Epping, Victoria, Australia
Department of General Medicine, The Northern Hospital, Epping, Victoria, Australia.
BMJ Case Rep. 2021 Feb 8;14(2):e240356. doi: 10.1136/bcr-2020-240356.
A 45-year-old man had recurrent presentations with pleuritic chest pain and shortness of breath. Four months prior, he had developed cauda equina syndrome from a spinal epidural abscess in the setting of intravenous drug use, complicated by lasting neurological deficits and a rectal prolapse. On his final presentation, blood cultures taken in the absence of antibiotics grew from multiple sets. A transoesophageal echocardiogram confirmed tricuspid valve endocarditis. He recovered well post-targeted long-term antibiotics. Endoscopy confirmed a chronic rectal prolapse with multiple ulcers and was hypothesised as the source of bacteraemia. He subsequently underwent perineal rectosigmoidectomy. This uncommon sequela of rectal prolapse highlights several issues, including the management of neurogenic bowel dysfunction following spinal cord injury and the importance of early prolapse recognition and management. Finally, appropriate collection of blood cultures and correct use of echocardiography are critical steps in investigating infective endocarditis.
一位 45 岁男性反复出现胸痛和呼吸困难。四个月前，他因静脉内药物使用引起的脊髓硬膜外脓肿导致马尾综合征，伴有持续的神经功能缺损和直肠脱垂。在最后一次就诊时，未使用抗生素时采集的血培养结果显示来自多个部位。经食道超声心动图证实为三尖瓣心内膜炎。他在接受靶向长期抗生素治疗后恢复良好。内窥镜检查证实存在慢性直肠脱垂伴多处溃疡，并推测这是菌血症的来源。随后他接受了会阴直肠乙状结肠切除术。直肠脱垂的这种罕见后遗症突出了几个问题，包括脊髓损伤后神经源性肠功能障碍的管理，以及早期识别和管理直肠脱垂的重要性。最后，正确采集血培养和正确使用超声心动图是调查感染性心内膜炎的关键步骤。
