Spondylodiscitis Associated with Major Abdominal Surgical Intervention: Challenging Diagnostic and Therapeutic...

Post-operative spondylodiscitis (PS) is a relatively rare infectious disease, with incidence varying from 0.21-3.6% in association with all surgical procedures. The entity appears insidiously, with non-specific symptoms such as neck or back pain, fever, muscle contractures, limited range of spinal motion, sciatica and neurological symptoms. C-reactive protein (CRP) remains the most reliable laboratory finding, while magnetic resonance imaging (MRI) has proven to be the most effective method for demonstrating the site of the infection. Treatment consists of immobilization along with antimicrobial therapy. The aim of this investigation was to analyse two isolated cases of PS presented in our institution. Into this retrospective survey were consecutively enrolled one patient with PS after complete common bile duct (CBD) obstruction and subsequent endoscopic retrograde cholangiopancreatography (ERCP) and Whipple operation along with one case of PS in a patient with vascular graft placement for therapeutic approach of an aortoenteric fistula as a consequence of an abdominal aorta pseudoaneurysm. PS is mainly associated with major surgical procedures and possesses a mortality rate of 11%. The most common etiological factor is Staphylococcus aureus but there is also evidence of gram-positive cocci, gram-negative bacilli, anaerobia bacteria, fungi, parasites and multi resistant microorganisms. Furthermore, there are many risk factors which contribute to this pathological situation such as advanced age, diabetes mellitus, smoking, steroid treatment, obesity, alcohol, malnutrition, concomitant infections, prolonged hospitalization and relevant serious co-morbidities. Also, the diagnosis is based on combination of clinical, haematological, microbiological and histopathologic findings.