The flatulent spine: lumbar spinal infection secondary to colonic diverticular abscess: a case report and review of the literature.

STUDY DESIGN

A case report and literature review.

OBJECTIVES

To present a case of lumbar spinal infection secondary to colonic diverticular disease, their management and outcome. To review the published literature on spinal involvement with gastrointestinal disease with a view to establishing guidelines for management.

SUMMARY OF BACKGROUND DATA

There is only 1 previous case report of spinal involvement in diverticular disease and 9 reports of spinal infection secondary to Crohn disease. Psoas abscess, osteomyelitis, cord and nerve root compression, meningitis, and hydronephrosis have all been documented. Infection is usually advanced at presentation and all but 1 patient was taking immunosuppressive drugs.

METHODS

Case notes and online databases were reviewed.

RESULTS

Management is similar for both Crohn and diverticular disease. Total parenteral nutrition and antibiotic treatment are required as is coordination between orthopedic surgeons, colorectal surgeons, and microbiologists. The spine and abdomen are best imaged with plain radiographs, magnetic resonance imaging and contrast enhanced computed tomography. Surgery involved a defunctioning stoma, debridement of abdominal and spinal infection, and instrumented stabilization of the spine if instability or vertebral collapse is likely. Operative specimens are most likely to identify the multiple enteric bacteria and fungi involved.

CONCLUSIONS

A multidisciplinary approach with aggressive supportive therapy, combined with a planned surgical procedure and appropriate antibiotics can give a good outcome in most cases.