Armstrong N, Schurr M, Helgerson R, Harms B
Department of General Surgery, University of Wisconsin Hospital and Clinics, Madison 53792, USA.
Dis Colon Rectum. 1998 Dec;41(12):1581-4. doi: 10.1007/BF02237311.
We report a unique case of Candida albicans sacral osteomyelitis in a 48 year-old female with previously undiagnosed Crohn's disease. The patient was ill for one year with fatigue, weakness, and a 60-lb weight loss. At the time of presentation, she developed chills, fever, right lower quadrant abdominal pain, and right knee pain. Physical examination was significant for a palpable right lower quadrant abdominal mass. A computed tomographic scan of the abdomen and pelvis identified a large right-sided retroperitoneal mass, severe right hydronephrosis, and air within the right sacrum. Findings at laparotomy included small-bowel changes consistent with Crohn's disease, a multiloculated retroperitoneal abscess, and evidence of sacral osteomyelitis. A right hemicolectomy with sacral debridement and placement of presacral drains was performed. Bone cultures from the sacrum demonstrated a predominance of C. albicans, in addition to coliforms and enterococcus. The patient was placed on amphotericin B and intravenous antibiotics. Because serial computed tomographic scans of her pelvis demonstrated progression of her pelvic osteomyelitis to include the sacrum, right ilium, right acetabulum, and right femoral head, a repeat debridement with resection of the right femoral head was performed. After 12 months of follow-up, she was doing well without medications and had no constitutional symptoms or radiographic evidence of disease progression. This report illustrates a unique case of Crohn's disease presenting as sacral osteomyelitis secondary to small-bowel fistulization. Aggressive multidisciplinary surgical and medical management were the key to the successful management of this difficult case.
我们报告了一例48岁女性患白色念珠菌性骶骨骨髓炎的独特病例，该患者此前未被诊断出患有克罗恩病。患者患病一年，伴有疲劳、虚弱和60磅体重减轻。就诊时，她出现寒战、发热、右下腹疼痛和右膝疼痛。体格检查发现右下腹可触及肿块。腹部和骨盆的计算机断层扫描显示右侧有一个巨大的腹膜后肿块、严重的右肾积水以及右侧骶骨内有气体。剖腹手术的发现包括与克罗恩病相符的小肠改变、多房性腹膜后脓肿以及骶骨骨髓炎的证据。进行了右半结肠切除术、骶骨清创术并放置了骶前引流管。骶骨的骨培养显示除大肠菌群和肠球菌外，白色念珠菌占优势。患者接受了两性霉素B和静脉抗生素治疗。由于对其骨盆进行的系列计算机断层扫描显示骨盆骨髓炎进展至包括骶骨、右髂骨、右髋臼和右股骨头，因此再次进行了清创术并切除了右股骨头。经过12个月的随访，她在未用药的情况下情况良好，没有全身症状或疾病进展的影像学证据。本报告阐述了一例以小肠瘘继发骶骨骨髓炎形式出现的独特克罗恩病病例。积极的多学科手术和药物治疗是成功处理这一疑难病例的关键。
