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Crohn's disease penetrating into the spinal canal
M Sacher1, H Göpfrich, O Hochberger
1G. v. Preyer'sches Kinderspital der Stadt Wien, Vienna, Austria.
Insights
Crohn
Area of Science:
- Gastroenterology and Neurology
- Pediatric Inflammatory Bowel Disease
- Spinal Infections
Background:
- Crohn's disease, a chronic inflammatory bowel condition, can present with extraintestinal manifestations.
- Spinal complications are rare but serious sequelae of Crohn's disease.
Observation:
- An 11-year-old boy with a 4-year history of Crohn's disease developed fever, severe back pain, and hip flexion contracture.
- Clinical presentation progressed to include radicular irritation and inability to walk.
- CT imaging revealed a psoas muscle abscess with extension into the spinal canal, forming an extradural abscess from L2-S4.
Findings:
- Surgical drainage of the psoas abscess combined with conservative management (steroids, hypercaloric diet) led to complete resolution.
- Successful treatment of both the psoas and spinal extradural abscesses.
Implications:
- Psoas and spinal epidural abscesses are rare but critical complications of Crohn's disease.
- Early consideration of spinal involvement is crucial in pediatric Crohn's patients presenting with significant back pain and neurological signs.
- Multidisciplinary management involving surgical and medical interventions is effective.
Abstract:
An 11-year-old boy who had suffered from Crohn's disease of the large bowel for 4 years developed high fever, severe back pain and flexion-contracture of the right hip joint with inability to walk. After several weeks radicular irritation also became apparent. CT-scan demonstrated an abscess of the right psoas muscle that had also infiltrated the spinal canal, leading to a spinal extradural abscess extending from L2-S4. Therapy comprised surgical drainage of the psoas abscess and conservative therapy (mainly steroids and hypercaloric diet) and resulted in complete cure of the psoas and the spinal abscess. Spinal infiltration is a rare and serious complication of Crohn's disease and must be considered in every case of significant back pain with or without obvious neurological signs.