Vertebral Osteomyelitis and Epidural Abscess after Laparoscopic Uterus-Preserving Cervicosacropexy

Keith T. Downing

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Abdominal sacrocolpopexy is a standard surgical technique to repair apical vaginal prolapse. When approached laparoscopically, a uterus-preserving technique was suggested as potentially favorable for avoiding mesh-related complications. A 52-year-old Caucasian woman came to the emergency department with right-sided low back pain and vaginal discharge more than 1 year after undergoing a laparoscopic, uterus-preserving, cervicosacropexy with Mersilene (Ethicon Inc., Somerville, NJ) mesh and permanent Gore-Tex (W.L. Gore and Associates, Inc., Flagstaff, AZ) suture. Lumbar spine magnetic resonance imaging revealed diskitis and an epidural abscess at the L5 to S1 vertebral levels, and a fistulous tract was identified extending from the rectovaginal space to the affected vertebrae. The patient underwent a fine-needle aspiration of the epidural abscess and intravenous antibiotic therapy was started. However, because of a lack of symptom resolution she was taken to the operating department on hospital day 11 and underwent a total abdominal hysterectomy, left salpingectomy, right salpingo-oophorectomy, bilateral ureterolysis, and excision of an infected Mersilene mesh. Surgical findings were notable for 2 pinpoint areas in the upper vagina consistent with fistulae tracts communicating with the retroperitoneal space. The patient recovered well from her surgery, and was discharged to a rehabilitation facility. Vertebral osteomyelitis, with or without an epidural abscess, is a rare complication of sacrocolpopexy. The findings of this case suggest this complication likely occurred as a result of a permanent suture being placed entirely (or nearly entirely) through the vaginal mucosa resulting in fistulae formation, bacterial seeding of the Mersilene mesh, and subsequent osteomyelitis. This highlights the importance of mesh and suture selection, and determining the most appropriate sites for mesh attachment.

Original languageEnglish (US)
Pages (from-to)370-372
Number of pages3
JournalJournal of Minimally Invasive Gynecology
Volume15
Issue number3
DOIs
StatePublished - May 2008
Externally publishedYes

Fingerprint

Epidural Abscess
Osteomyelitis
Sutures
Uterus
Fistula
Spine
Salpingectomy
Retroperitoneal Space
Uterine Prolapse
Discitis
Vaginal Discharge
Hospital Departments
Ovariectomy
Vagina
Fine Needle Biopsy
Low Back Pain
Hysterectomy
Hospital Emergency Service
Mucous Membrane
Rehabilitation

Keywords

  • Abdominal sacrocolpopexy
  • Epidural abscess
  • Laparoscopic cervicosacropexy
  • Mesh erosion
  • Pelvic organ prolapse
  • Uterine preservation
  • Vaginal fistula
  • Vertebral osteomyelitis

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Vertebral Osteomyelitis and Epidural Abscess after Laparoscopic Uterus-Preserving Cervicosacropexy. / Downing, Keith T.

In: Journal of Minimally Invasive Gynecology, Vol. 15, No. 3, 05.2008, p. 370-372.

Research output: Contribution to journalArticle

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