Bacterial Sacroiliitis and Gluteal Abscess After Dilation and Curettage for Incomplete Abortion

Yansouni, Cédric P.; Ponette, Vincent; Rouleau, Danielle

doi:10.1097/aog.0b013e3181a45c60

Cited by 8 publications

(10 citation statements)

References 10 publications

(3 reference statements)

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“…Similarly to our series, the most frequent clinical sign recorded in other reports was lumbogluteal pain [1-4,6,10-12], whereas coxofemoral pain, pubalgia, abdominal pain, and psoitis were also observed [1,3,9]. Although rarely performed, manipulation of the SI joint is often very painful [3,8,10-12].…”

Section: Discussionsupporting

confidence: 86%

Infectious sacroiliitis: a retrospective, multicentre study of 39 adults

et al. 2012

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BackgroundNon-brucellar and non-tuberculous infectious sacroiliitis (ISI) is a rare disease, with misleading clinical signs that delay diagnosis. Most observations are based on isolated case reports or small case series. Our aim was to describe the clinical, bacteriological, and radiological characteristics of ISI, as well as the evolution of these arthritis cases under treatment.MethodsThis retrospective study included all ISI cases diagnosed between 1995 and 2011 in eight French rheumatology departments. ISI was diagnosed if sacroiliitis was confirmed bacteriologically or, in the absence of pathogenic agents, if clinical, biological, and radiological data was compatible with this diagnosis and evolution was favourable under antibiotic therapy.ResultsOverall, 39 cases of ISI were identified in adults, comprising 23 women and 16 men, with a mean age at diagnosis of 39.7 ± 18.1 years. The left sacroiliac joint (SI) was affected in 59% of cases, with five cases occurring during the post-partum period. Lumbogluteal pain was the most common symptom (36/39). Manipulations of the SI joint were performed in seven patients and were always painful. Mean score for pain using the visual analogue score was 7.3/10 at admission, while 16 patients were febrile at diagnosis. No risk factor was found for 30.7% of patients. A diagnosis of ISI was only suspected in five cases at admission. The mean time to diagnosis was long, being 43.3 ± 69.1 days on average. Mean C-reactive protein was 149.7 ± 115.3 mg/l, and leukocytosis (leukocytes ≥ 10 G/l) was uncommon (n = 15) (mean level of leukocytes 10.4 ± 3.5 G/l). Radiographs (n = 33) were abnormal in 20 cases, revealing lesions of SI, while an abdominopelvic computed tomography (CT) scan (n = 27) was abnormal in 21 cases, suggesting arthritis of the SI joints in 13 cases (48.1%) and a psoas abscess in eight. Bone scans (n = 14) showed hyperfixation of the SI in 13 cases. Magnetic resonance imaging (MRI) (n = 27), when focused on the SI (n = 25), directed towards the diagnosis to ISI in 25 cases. Pathogenic agents were isolated in 33 cases (84.6%) by means of articular puncture (n = 16), blood culture (n = 14), cytobacteriological examination of urine (n = 2), or puncture of the psoas (n = 1).Gram-positive cocci were the mostly isolated common bacteria, with a predominance of staphylococci (n = 21). The most frequently isolated gram-negative bacillus was Pseudomonas aeruginosa (n = 3). Evolution was favourable in 37 out of 39 patients under prolonged antibiotic therapy (mean duration 3.01 ± 1.21 months).ConclusionOur series confirmed that the clinical manifestations of ISI usually lead to delayed diagnosis. Based on our results, we suggest performing an MRI of the spine and SI in clinical situations characterised by lumbogluteal pain and symptoms of an infectious disease, such as fever.

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Section: Discussionsupporting

confidence: 86%

Infectious sacroiliitis: a retrospective, multicentre study of 39 adults

et al. 2012

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“…Most procedures occur without any adverse events; however, a few can be complicated by hemorrhage, uterine perforation, retained uterine products, or infection [1Y4]. Most data regarding infectious complications after a D&E in the medical literature pertain to elective abortions [1]. In a series of 170,000 elective abortions performed between 1971 and 1987, Hakim-Elahi et al [5] reported 36 cases (0.021%) complicated by sepsis and 784 cases (0.46%) complicated by minor infections, with occurrence rates of 1 in 4,722 and 1 in 216, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…E xtrauterine infections are rare but potentially lifethreatening complications that may occur after a dilation and evacuation (D&E) for an incomplete abortion or fetal loss [1]. These infections may manifest in the form of sepsis, endocarditis, or intra-abdominal abscesses; however, infections of the surrounding pelvic bones or muscles after D&E procedures are exceedingly rare [1Y3].…”

mentioning

confidence: 99%

Iliopsoas Abscess

Pereira

Bardawil

Patel

et al. 2014

Journal of Lower Genital Tract Disease

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“…[2] However, some forms of extrauterinal abscess after D and C, such as anaerobic breast abscess,[3] septic arthritis and thigh abscess caused by β-haemolytic streptococci ,[4] psoas abscess caused by Staphylococcus aureus [5] and bacterial sacroliliitis and gluteal abscess caused by Streptococcus agalactiae [6] have been rarely reported. These manifestations were not associated with any underlying diseases, and most of them eventually required surgical drainage.…”

Section: Discussionmentioning

confidence: 99%

Spinal epidural abscess caused by Bacteroides fragilis group after dilation and curettage for incomplete abortion

Ohyagi

Ohkubo

Taniyama

et al. 2012

J Global Infect Dis

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Spinal epidural abscess (SEA) is a rare infection complicated in patients who have some risk factors such as injection-drug use, diabetes mellitus, and several illnesses. However, no case of SEA associated with abortion has been reported. Here we report a case of SEA in a 30-year-old woman after dilation and curettage for incomplete abortion. The diagnosis of SEA was done by MRI and pus was drained after the cervical discectomy. Bacteroides fragilis group was cultured from the aspirated pus sample. The patient responded to surgical drainage and antibiotics.

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Bacterial Sacroiliitis and Gluteal Abscess After Dilation and Curettage for Incomplete Abortion

Abstract: Although very rare, serious pyogenic complications of dilation and curettage after incomplete abortion do occur and may present a diagnostic challenge.

Cited by 8 publications

References 10 publications

Infectious sacroiliitis: a retrospective, multicentre study of 39 adults

Infectious sacroiliitis: a retrospective, multicentre study of 39 adults

Iliopsoas Abscess

Spinal epidural abscess caused by Bacteroides fragilis group after dilation and curettage for incomplete abortion

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