Osteitis pubis: an unusual complication of herniorrhaphy

Osteitis pubis is a well known complication of urologic and gynecologic procedures but its association with herniorrhaphy is poorly documented in the literature. A 55-year-old man underwent herniorrhaphy for a direct inguinal hernia, followed in 48 hours by herniorrhaphy for a femoral hernia. One week later he complained of pain in the pubic area and over the ischial tuberosities, had intermittent fever and an elevated erythrocyte sedimentation rate. Roentgenograms showed changes typical of osteitis pubis with widening of the symphysis pubis, loss of definition of the adjacent cortical surfaces and involvement of the ischial tuberosities. There ws no evidence of infection in the urinary tract or elsewhere. The patient was treated with indomethacin and showed clinical and radiologic improvement over the next 6 months. It is possible that in this case two operative interventions involving structures inserting into the pubic bones and performed within a short time of each other exposed this patient to an unusual complication.