J Korean Soc Spine Surg.  2009 Sep;16(3):222-227. 10.4184/jkss.2009.16.3.222.

The Rectal Fistula Complicating an L5-S1 Postoperative Spondylodiscitis: A Case Report

Affiliations
  • 1Department of Orthopedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
  • 2Department of Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
  • 3Department of Orthopedic Surgery, Chunchon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea. seo-em@hanmail.net

Abstract

To our knowledge, there are no reported cases of rectal fistula complicating spondylodiscitis. We report the first case of a rectal fistula communicating with the site of postoperative recurrent spondylodiscitis. A-59-year-old female had recurrent spondylodiscitis after an open discectomy for L5-S1 eight years earlier. She underwent three operations including two anterior lumbar interbody fusion procedures after an open discectomy. Radiographic studies revealed severe bony destruction with abscess collection within the L5-S1 intervertebral disc space with fistula formation into the rectum. The fistula was confirmed by a Barium enema colon study and sigmoidscopy. The patient underwent a staged operation consisting of a rectosigmoid colon resection, anterior interbody fusion and posterior instrumented fusion. Rectum related complications were suspected in this case of recurrent spondylodiscitis.

Keyword

Spondylodiscitis; Rectal fistula

MeSH Terms

Abscess
Barium
Colon
Discitis
Diskectomy
Enema
Female
Fistula
Humans
Intervertebral Disc
Rectal Fistula
Rectum
Barium

Figure

  • Fig. 1. Plain radiographs of the lumbar spine showing a narrowed disc space at L5-S1 with endplate destruction, reactive sclerosis of the vertebral bodies.

  • Fig. 2. (A, C) T2-weighted and (B, D) T1-weighted contrast enhanced MR sagittal images showing an abscess in L5-S1 disc space, extending into the rectum (arrows) and the epidural space (arrow heads).

  • Fig. 3. Barium enema colon study showing dye leakage into L5-S1 disc space.

  • Fig. 4. Photographs showing two orifices at the 15cm upper portion from the anal verge on sigmoidscopy.

  • Fig. 5. Intraoperative photographs showing resection and reanastomosis procedure of the rectum (A) and rectal specimen with fistula (B).

  • Fig. 6. Radiographs of lumbar spine showing posterior instrumentation and posterolateral fusion at L4-5-S1 vertebra to restore the mechanical integrity of the spinal motion segments.

  • Fig. 7. CT scans showing incomplete bony union of autogenous fibula bone graft at L5-S1 (A) but bony union of L4-5-S1 posterolateral fusion (B,C).


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