title: Chronic pelvic pain reveals sacral osteomyelitis three years after abdominal hysterectomy.
abstract: BACKGROUND
  Deep pelvic abscess is a well-known infective complication in gynecologic practice. However, sacral osteomyelitis has been reported rarely. We describe sacral infection presenting three years after abdominal hysterectomy and point out the difficulty in management.
  
  
  METHODS
  Case report and review of the pertinent literature.
  
  
  RESULTS
  A 46-year-old woman who had undergone abdominal hysterectomy three years before presented with an 8-month history of abdominopelvic pain recently intensifying in the sitting position without fever. Gynecologic, urinary, and rectal examination did not yield positive findings. An abdominopelvic computed tomography (CT) scan was normal except for sacral osteolysis. A neoplasm was suspected, but magnetic resonance imaging revealed an S2-S4 cystic collection with presacral extension. Neurologic examination did not show any focal deficits. A posterior CT-guided biopsy-aspiration yielded purulent fluid. Pathologic examination revealed inflammatory granulations without any malignant tumor. Abscess cultures grew three microorganisms. The patient's symptoms resolved completely after 3 months of antibiotic therapy.
  
  
  CONCLUSIONS
  Sacral osteomyelitis has not been reported previously after abdominal hysterectomy. Early diagnosis was made difficult by the absence of neurologic findings. Such postoperative infection should be considered after pelvic surgery. Minimally invasive needle aspiration may confirm the diagnosis and reduce the necessary extent of surgical intervention.
authors: Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco. akhaddar@hotmail.fr
authors: Ali
authors: A
authors: Akhaddar
authors: Mohammed
authors: M
authors: Mahi
authors: Mostapha
authors: M
authors: Elouennass
authors: Redouane
authors: R
authors: Niamane
authors: Brahim
authors: B
authors: Elmoustarchid
authors: Mohammed
authors: M
authors: Boucetta
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D001706:Biopsy; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000382:microbiology; D017699:Pelvic Pain / Q000209:etiology*; D011859:Radiography; D012447:Sacrum / Q000000981:diagnostic imaging / Q000473:pathology*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents