A Case of Spinal Epidural and Pelvic Abscess with the Rectal Perforation

Hiroaki Shima, Eiri Ezoe, Osamu Nara¹⁾, Koji Hashimoto¹⁾, Reiko Kyan¹⁾, Masato Isobe, Tomohisa Furuhata, Naoya Yama²⁾, Yasufumi Asai and Koichi Hirata

First Department of Surgery, Department of Traumatology and Critical Care Medicine¹⁾ and Department of Radiology²⁾, Sapporo Medical University School of Medicine

We report a rare case of spinal epidural and pelvic abscess with rectal perforation in a 38-year-old man admitted for a nutrition disorder. He suffered from fever soon after hospitalization and numbness of the right sole foot after one month, complicated further by right leg weakness and vesicorectal dysfunction such as dyschezia and urinary disturbance. Magnetic resonance imaging (MRI) strongly suspected atypical epidural abscess. We received a request for interpretation of this MRI finding by the radiologist and these films were soon executed by a radiologist at our facility. The MRI suggested active inflammation or abscess due to pathological changes in the rectum. We then placed him in intensive care. Although no ascites was seen in the free space in peritoneal cavity in enhanced computed tomography, contrast enema of the rectum showed leakage of the X-ray contrast agent into the pelvic space, indicating rectal perforation necessitating laminectmy, rectal resection and colostomy. This disease is difficult to diagnose in the early stage, because early symptoms are frequently absent or non-specific. Pelvic suppuration and epidural abscess symptoms were cured, with no neurological after effects. Relative early treatment, coordinated with community health care also contributed to this successful outcome.

Key words
epidural abscess, rectal perforation, pelvic suppuration

Reprint requests
Hiroaki Shima First Department of Surgery, Sapporo Medical University School of Medicine
S1 W16 Chuo-ku, Sapporo, 060-8543 JAPAN

Accepted
October 25, 2006

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