title: Sacral osteomyelitis after laparoscopic sacral colpopexy performed after a recent dental extraction: a case report.
abstract: BACKGROUND
  Sacral osteomyelitis and subsequent discitis is a rare complication after laparoscopic sacral colpopexy to repair apical vaginal prolapse.
  
  
  METHODS
  We present a patient who developed Bacteroides fragilis sacral osteomyelitis and discitis after laparoscopic sacrocolpopexy with synthetic monofilament mesh and sacral titanium coil fixation. The patient had undergone dental extraction of 3 infected teeth approximately 2 weeks before sacrocolpopexy for stage IV apical vaginal prolapse. Computed tomography and magnetic resonance imaging (MRI) confirmed sacral osteomyelitis and discitis along with Bacteroides fragilis bacteremia approximately a week and a half after the original surgery. The patient was followed up with serial MRIs of the spine which revealed degeneration at the sacral promontory. The patient underwent successful removal of the entire mesh and sacral titanium coils with resolution of her symptoms. Follow-up MRI of the spine revealed resolution of her sacral osteomyelitis.
  
  
  CONCLUSIONS
  Sacral osteomyelitis is a rare complication after sacrocolpopexy for pelvic organ prolapse repair. There should be a high index of suspicion for patients presenting with disproportionate low back pain and vague symptoms after surgery. Recent oral surgery may increase the risk of bacteremia and subsequent infectious morbidity after sacrocolpopexy with the use of synthetic mesh for prolapse repair.
authors.affiliation: From the *Urogynecology and Pelvic Reconstructive Surgery, Akron General Medical Center/Northeast Ohio Medical University, Akron, OH; and †Kansas City University of Medicine and Biosciences, Kansas City, MO.
authors.forename: Costas A
authors.initials: CA
authors.lastname: Apostolis
authors.forename: Cassandra
authors.initials: C
authors.lastname: Heiselman
mesh_terms: D000368:Aged; D001442:Bacteroides Infections / Q000209:etiology*; D001441:Bacteroides fragilis; D015299:Discitis / Q000209:etiology; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D010019:Osteomyelitis / Q000209:etiology*; D056887:Pelvic Organ Prolapse / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012447:Sacrum / Q000601:surgery*; D014081:Tooth Extraction / Q000009:adverse effects*; D014621:Vagina / Q000601:surgery