[A CASE OF PYOGENIC SPONDYLITIS CAUSED BY MESH INFECTION AFTER LAPAROSCOPIC SACROCOLPOPEXY]

We report a case involving an 81-year-old woman who developed pyogenic spondylitis following laparoscopic sacrocolpopexy (LSC) for a cystocele in November year X. During concomitant uterine resection, purulent discharge was observed, and oral levofloxacin was administered for 5 days postoperatively. Pathological examination revealed xanthogranulomatous endometritis, which was considered the source of the mesh infection. The patient was discharged on postoperative day 7 without complications. In early January year X＋1, she developed buttock pain that persisted for approximately 2 weeks without improvement, prompting her to return to our hospital. Magnetic resonance imaging findings indicated pyogenic spondylitis. She was admitted and treated with intravenous sulbactam/ampicillin for 1 week, but her symptoms did not improve. Laparoscopic mesh removal was subsequently performed. After surgery, the antibiotic regimen was switched to intravenous imipenem/cilastatin, resulting in good infection control. However, progressive bone destruction was noted, and on postoperative day 37, posterior spinal fusion from L3 to the pelvis was performed by our orthopedic team. The postoperative course following spinal surgery was favorable, with marked symptom relief. Oral minocycline was initiated on postoperative day 69 and continued until day 133. The patient was discharged ambulatorily on postoperative day 139. Although pyogenic spondylitis is recognized as a serious complication of LSC, this represents postoperative case encountered at our institution. On the basis of a review of the literature, we discuss this case and its clinical implications.