We present the case of a 76-year-old woman with a past medical history of hypertension, chronic heart failure and chronic low back pain who developed spondylodiscitis after laparoscopic rectopexy for rectal prolapse and cystopexy for grade III cystocele without urinary incontinence. Two polypropylene strips were fixed by a non-absorbable stitch on the rectum and the vagina. The two strips were then stretched and fixed to the promontory by nonabsorbable polyester stitch. One month after surgery, the patient reported severe back pain and was hospitalized in the rheumatology department. She had no neurological symptoms. Laboratory tests highlighted an inflammatory syndrome (white blood cell count: 22 g/l). Thoracolumbar magnetic resonance imaging (MRI) revealed a suspicious contrast enhancement on the 5th lumbar vertebra (L5) and epiduritis extending from the 2nd lumbar vertebra (L2) to the 1st sacral vertebra (S1). The patient developed fever during hospitalization due to Escherichia coli bacteremia. Antibiotic therapy with ceftriaxone and ofloxacin was started. Additional diagnostic imaging was performed: bone scintigraphy with Tc 99m showed a uptake in the 2nd to 4th lumbar vertebrae; an abdominopelvic computed tomography (CT) scan revealed a large air-fluid collection communicating via a fistula with the anterolateral wall of the lower rectum and the intervertebral discs L5-S1A (Fig. 1). The diagnosis of spondylodiscitis L5-S1 complicating peritoneal abscess was made. As non-invasive management was impossible, the patient was scheduled for surgery. Intraoperative findings were a large stercoral abscess at the iliac confluent and two perforations of the lower rectum. Hartmann's procedure was performed with a low section of the rectum, and the pelvis was drained with a Mikulicz bag. The post-operative course was uneventful: antibiotics were continued intravenously for 3 weeks and a surgical corset immobilized the lumbar spine. The restoration of continuity was performed 9 months after the second surgery and the patient recovered completely.Spondylodiscitis after rectopexy is a serious complication which can be life threatening. It can occur from several weeks to several years after surgery. Practitioners should therefore know the clinical symptoms of this disease in order to consider this diagnosis. Spondylodiscitis symptoms are often intense back pain during the night. Fever is inconstant (about 50% of cases). When neurological deficits (motor or sensory) of the lower limbs or radicular pain are associated, emergency surgery is needed [1]. Diagnostic tests are biological: inflammation (increased white blood cell count and C-reactive protein level), blood cultures may be negative, necessitating CT-guided biopsy of the spinal disc for bacteriological and histological analysis. New blood cultures should be performed after this biopsy [1]. The morphological assessment includes thoracolumbar CT scan (hypodensity of infected tissues) and especially MRI showing a hypointensity of the vertebral body on gadolinium enhance...
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