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Sacral osteomyelitis: an unusual complication of abdominal sacral colpopexy
A C Weidner1, G W Cundiff, R L Harris
1Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Background:
Abdominal sacral colpopexy using permanent mesh is an established technique for repair of vaginal vault prolapse. Infection is not a frequent complication. We report two cases of lumbosacral osteomyelitis treated with intravenous antibiotics without mesh removal.
Cases:
The first patient had known advanced degenerative arthritis. Unremitting severe low back pain 5 years after abdominal sacral colpopexy prompted magnetic resonance imaging (MRI), revealing osteomyelitis and diskitis. The second patient developed symptoms 2 months postoperatively, and MRI indicated osteomyelitis with epidural abscess. Both patients received intravenous antibiotics, and neither required surgical debridement or mesh removal.
Conclusion:
Osteomyelitis can present remote from the operation and can be difficult to diagnose. Protracted parenteral antibiotic therapy can be definitive treatment without mesh removal.
Insights
Abdominal sacral colpopexy can lead to rare lumbosacral osteomyelitis. This infection, even years later, may resolve with intravenous antibiotics alone, avoiding mesh removal.
Area of Science:
- Gynecologic surgery
- Infectious disease
- Orthopedic surgery
Background:
- Abdominal sacral colpopexy with permanent mesh is a standard procedure for vaginal vault prolapse.
- Infection is an uncommon complication of this surgery.
Observation:
- Two cases of lumbosacral osteomyelitis following abdominal sacral colpopexy are presented.
- One patient developed symptoms 5 years post-surgery, the other 2 months post-surgery.
- Magnetic resonance imaging (MRI) confirmed osteomyelitis and diskitis in one case and osteomyelitis with epidural abscess in the other.
Findings:
- Both patients were successfully treated with intravenous antibiotics.
- Neither patient required surgical debridement or removal of the permanent mesh.
- Osteomyelitis presented remotely from the initial surgery and was challenging to diagnose.
Implications:
- Prolonged parenteral antibiotic therapy can be a definitive treatment for mesh-related osteomyelitis.
- This approach avoids the need for mesh removal in select cases of infection.
- Highlights the importance of considering delayed infectious complications after sacral colpopexy.
