Chronic pelvic pain reveals sacral osteomyelitis three years after abdominal hysterectomy.
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.
Akhaddar
Ali
A
Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco. akhaddar@hotmail.fr
Mahi
Mohammed
M
Elouennass
Mostapha
M
Niamane
Redouane
R
Elmoustarchid
Brahim
B
Boucetta
Mohammed
M
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
D000900:Anti-Bacterial Agents