Sacral osteomyelitis after ileal pouch-anal anastomosis: report of four cases.
OBJECTIVE
This study describes an institutional experience with sacral osteomyelitis after proctocolectomy and ileal pouch-anal anastomosis.


METHODS
A total of 2,375 patients underwent ileal pouch-anal anastomosis at the Mayo Clinic between January 1981 and January 2002. In addition, we have served as a tertiary referral base for patients with complications after ileal pouch-anal anastomosis performed at other institutions. Review of our ileal pouch-anal anastomosis prospective database and directed search of the central pathology, microbiology, radiology, and surgical records at the Mayo Clinic was performed using these keywords: osteomyelitis, ileal pouch-anal anastomosis, inflammatory bowel disease, chronic ulcerative colitis, and Crohn's disease.


RESULTS
Two of 2,375 patients (0.08 percent) with ileal pouch-anal anastomosis performed at our institution have had sacral osteomyelitis. In addition, two patients have been referred for continuing care after construction of an ileal pouch-anal anastomosis and diagnosis of sacral osteomyelitis at another institution. Two of the four patients maintained normal pouch function after sacral debridement and a period of fecal stream diversion. One patient remains diverted with resolved sacral osteomyelitis after debridement. The last patient died from squamous-cell cancer involving the sacrum.


CONCLUSIONS
Sacral osteomyelitis is a rare and heretofore unreported complication of ileal pouch-anal anastomosis. Conservative measures using antibiotics alone proved unsuccessful, and delaying definitive management may have contributed to the degeneration of a chronic sacral abscess into squamous-cell cancer. With more aggressive treatment comprising sacral debridement, long-term antibiotics, and fecal diversion, pouch function can potentially be preserved.
Taylor
William E
WE
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Wolff
Bruce G
BG
Pemberton
John H
JH
Yaszemski
Michael J
MJ
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012447:Sacrum