放射性直肠炎相关性腰椎间盘炎：一种罕见的发现。
Radiation proctitis-related lumbar spondylodiscitis due to : a rare finding.
机构信息
Internal Medicine Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Lisbon, Portugal
Hospital de Vila Franca de Xira, Vila Franca de Xira, Lisbon, Portugal.
出版信息
BMJ Case Rep. 2021 Jul 12;14(7):e237047. doi: 10.1136/bcr-2020-237047.
Lumbar spondylodiscitis due to radiation proctitis-related fistula is a rare finding in the literature. After having isolated , a rare finding in the osteomuscular system, we present one of such cases.A 75-year-old patient with a history of rectum adenocarcinoma, submitted to surgery and radiotherapy, presented himself in our emergency department with a 3-month history of lumbar pain radiating to both legs. Physical examination was compatible with cauda equina syndrome and subsequent investigation revealed L4-L5 spondylodiscitis. Despite a 6-month antibiotic therapy regimen, the symptoms recurred. Intravertebral disc biopsy revealed and directed antibiotic therapy was started. However, the symptoms recurred after a new 6-month antibiotic therapy regimen, this time with rectal purulent drainage. Additional study revealed two rectal fistulae. It was assumed those were caused by radiation proctitis and constituted the primary cause of spondylodiscitis. Laminectomy was performed with a satisfactory clinical response.
因放射性直肠炎相关瘘管导致的腰椎骨盘炎在文献中较为罕见。我们发现了一例罕见的发生于肌肉骨骼系统的病例，现报道如下。一位 75 岁的男性患者，既往患有直肠腺癌，曾接受手术和放疗，因腰痛伴双下肢放射痛 3 个月就诊于我院急诊科。体格检查符合马尾综合征，随后的检查显示 L4-L5 腰椎骨盘炎。尽管接受了 6 个月的抗生素治疗方案，症状仍复发。经椎间盘活检发现 ，开始了针对性的抗生素治疗。然而，在新的 6 个月抗生素治疗方案后，症状再次出现，此时伴有直肠脓性分泌物。进一步的研究显示存在两个直肠瘘。推测这些瘘管是由放射性直肠炎引起的，是导致腰椎骨盘炎的主要原因。行椎板切除术，患者的临床症状得到了满意的缓解。
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