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Enterococcus faecalis causing delayed spondylodiscitis in a case with retained intraspinal bullet.

Siddharth N Aiyer1, Ajoy Prasad Shetty1, Rishi Kanna1

  • 1Department of Spine Surgery, Ganga Hospital, Coimbatore, India.

Journal of Spine Surgery (Hong Kong)
|January 19, 2017
PubMed
Summary

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Delayed spinal infection can occur months after abdominal gunshot wounds with retained bullets. This case highlights late-onset pyogenic spondylodiscitis and neurological issues, emphasizing the need for vigilance in managing such injuries.

Area of Science:

  • Spinal surgery
  • Infectious disease
  • Trauma surgery

Background:

  • Delayed presentations of spinal gunshot wounds (GSW) can result from projectile migration or lead intoxication.
  • Pyogenic spondylodiscitis and neurological deficits are potential complications of retained intraspinal projectiles.
  • Colonic perforation following GSW increases the risk of infectious complications, typically in the early postoperative period.

Observation:

  • A 55-year-old male presented 4 months post-GSW to the abdomen with colonic injury and L5 fracture.
  • Initial treatment included colonic repair and antibiotics, without bullet retrieval.
  • The patient developed low back pain and claudication, indicating pyogenic spondylodiscitis at L5-S1.

Findings:

  • Surgical debridement and stabilization were performed for the L5-S1 infective focus.
Keywords:
Enterococcus faecalisSpondylodiscitiscolonic injurygunshot wound (GSW)retained bullet

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  • Biopsy confirmed spondylodiscitis, with Enterococcus faecalis isolated from the lesion.
  • The patient recovered after antibiotic treatment and surgical fusion.

    • Implications:

    • This case illustrates a rare instance of late-onset spinal infection following a GSW with a retained projectile and associated colonic perforation.
    • It underscores the possibility of delayed infectious complications beyond the typical early postoperative window.
    • Vigilance for late-onset spinal infections is crucial in patients with penetrating abdominal trauma and retained intraspinal foreign bodies.