Vertebral discitis after laparoscopic resection rectopexy: a rare differential diagnosis

Area of Science:

• Spinal infections
• Surgical complications
• Infectious diseases

Background:

• Vertebral discitis typically results from hematogenous spread of pathogens.
• Laparoscopic surgery, particularly with sutures on the promontory, presents a rare but potential cause of discitis.
• Rectal prolapse surgery is a specific context where this complication may arise.

Observation:

• An 81-year-old woman developed severe lower back pain radiating to her legs post-laparoscopic resection rectopexy.
• Symptoms persisted despite symptomatic treatment.
• Lumbar spine MRI revealed vertebral osteomyelitis and discitis two months after surgery.

Findings:

• The surgical fixation on the promontory may have caused trauma, predisposing the spine to infection.
• Persistent, severe back pain in post-operative patients warrants a high index of suspicion for spinal infection.
• Microbiological analysis of an adequate specimen is essential for identifying the causative pathogen.

Implications:

• Timely diagnosis requires a combination of thorough patient history, advanced imaging, and microbiological testing.
• Effective management involves targeted, prolonged antimicrobial therapy.
• This case highlights the importance of considering surgical complications in the differential diagnosis of persistent back pain.