Osteomyelitis secondary to sacral colpopexy mesh erosion requiring laminectomy
G Bernard Taylor1, Robert D Moore, John R Miklos
1Atlanta Urogynecology Associates, Alpharetta, Georgia 30005, USA. Taylor704g@aol.com
Background:
Severe infectious morbidity associated with the use of synthetic mesh and abdominal sacral colpopexy is rare. Pelvic abscess, sinus tract formation, enterovaginal fistula, and osteomyelitis have been reported.
Case:
This case involves a patient who presented with staphylococcal bacteremia and vaginal erosion of a sacral colpopexy synthetic mesh. Despite prolonged courses of intravenous antibiotics and complete removal of the mesh material, she developed osteomyelitis. Progressive neurologic symptoms required a decompression laminectomy to facilitate a complete recovery and resolution of symptoms.
Conclusion:
In the treatment of abdominal sacral colpopexy mesh erosion, we recommend maintaining a high index of suspicion for secondary infections.
Insights
Severe infectious complications from synthetic mesh in abdominal sacral colpopexy are rare but serious. This case highlights the risk of secondary infections like osteomyelitis, even after mesh removal and antibiotic treatment.
Area of Science:
- Urogynecology and reconstructive pelvic surgery.
- Infectious disease complications in surgical implants.
Background:
- Synthetic mesh is used in abdominal sacral colpopexy for pelvic organ prolapse.
- Severe infectious complications, though rare, include abscess, fistula, and osteomyelitis.
Observation:
- A patient presented with staphylococcal bacteremia and vaginal erosion of synthetic mesh post-colpopexy.
- Despite antibiotics and mesh removal, osteomyelitis developed.
- Neurologic symptoms necessitated laminectomy for recovery.
Findings:
- Mesh erosion can lead to severe, persistent infections.
- Osteomyelitis is a potential complication requiring aggressive management.
- Surgical intervention may be needed for neurologic compromise.
Implications:
- Maintain a high suspicion for secondary infections in mesh erosion cases.
- Prompt diagnosis and multidisciplinary management are crucial for favorable outcomes.
- Consider long-term monitoring for patients with synthetic mesh complications.