The Rectal Fistula Complicating an L5-S1 Postoperative Spondylodiscitis

Sang-Hun Lee; Eun-Min Seo; Sung-Il Choi; Ki-Tack Kim

doi:10.4184/jkss.2009.16.3.222

Journal List > J Korean Soc Spine Surg > v.16(3) > 1035858

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Lee, Seo, Choi, and Kim: The Rectal Fistula Complicating an L5-S1 Postoperative Spondylodiscitis

A Case Report

Journal of Korean Spine Surg 2009;16(3):222-227.

Published online: 21 February 2009

DOI: https://doi.org/10.4184/jkss.2009.16.3.222

The Rectal Fistula Complicating an L5-S1 Postoperative Spondylodiscitis

Sang-Hun Lee, M.D., Eun-Min Seo, M.D.^†,, Sung-Il Choi, M.D.^∗, Ki-Tack Kim, M.D.

Department of Orthopedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea

^∗Department of Surgery, Kyung Hee University School of Medicine, Seoul, Korea

^†Department of Orthopedic Surgery, Chunchon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea

Address reprint requests to Eun-Min Seo, M.D. Department of Orthopedic Surgery, Chunchon Sacred Heart Hospital, Hallym University College of Medicine, 153, Gyo-dong, Chuncheon, Kangwon-do, 200-704, Korea Tel : 82-33-240-5781, Fax : 82-33-255-6244, E-mail: seo-em@hanmail.net.

Received 30 January 2009 Accepted 2 July 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

To our knowledge, there are no reported cases of rectal fistula complicating spondylodiscitis. We report the first case of a rectal fistula communicating with the site of postoperative recurrent spondylodiscitis. A-59-year-old female had recurrent spondylodiscitis after an open discectomy for L5-S1 eight years earlier. She underwent three operations including two anterior lumbar interbody fusion procedures after an open discectomy. Radiographic studies revealed severe bony destruction with abscess collection within the L5-S1 intervertebral disc space with fistula formation into the rectum. The fistula was confirmed by a Barium enema colon study and sigmoidscopy. The patient underwent a staged operation consisting of a rectosigmoid colon resection, anterior interbody fusion and posterior instrumented fusion. Rectum related complications were suspected in this case of recurrent spondylodiscitis.

Keywords: Spondylodiscitis, Rectal fistula

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Fig. 1.

Plain radiographs of the lumbar spine showing a narrowed disc space at L5-S1 with endplate destruction, reactive sclerosis of the vertebral bodies.

Fig. 2.

(A, C) T2-weighted and (B, D) T1-weighted contrast enhanced MR sagittal images showing an abscess in L5-S1 disc space, extending into the rectum (arrows) and the epidural space (arrow heads).

Fig. 3.

Barium enema colon study showing dye leakage into L5-S1 disc space.

Fig. 4.

Photographs showing two orifices at the 15cm upper portion from the anal verge on sigmoidscopy.

Fig. 5.

Intraoperative photographs showing resection and reanastomosis procedure of the rectum (A) and rectal specimen with fistula (B).

Fig. 6.

Radiographs of lumbar spine showing posterior instrumentation and posterolateral fusion at L4-5-S1 vertebra to restore the mechanical integrity of the spinal motion segments.

Fig. 7.

CT scans showing incomplete bony union of autogenous fibula bone graft at L5-S1 (A) but bony union of L4-5-S1 posterolateral fusion (B,C).

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