Pyogenic spondylodiscitis of the lumbar spine related to anastomotic fistula after surgery for esophageal cancer: a case report

Springer Science and Business Media LLC - Tập 6 Số 1 - 2020
Yuichi Akama1, Takeshi Matsutani2,1, Nobutoshi Hagiwara1, Hiroki Umezawa3, Tsutomu Nomura1, Hideki Hanawa2, Keisuke Mishima2, Nobuhiko Taniai2, Hiroshi Yoshida1
1Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
2Department of Digestive Surgery, Nippon Medical School Musashi Kosugi Hospital, Kawasaki-shi, Japan
3Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan

Tóm tắt

Abstract Background Pyogenic spondylodiscitis is an extremely rare complication of esophagectomy for esophageal cancer. Case presentation A 70-year-old Japanese man, with a previous medical history of type 2 diabetes mellitus, coronary artery disease, and laryngeal cancer, received neoadjuvant chemotherapy and underwent thoracoscopic esophagectomy with gastric tube reconstruction for advanced esophageal cancer. Cervical esophagogastrostomy with circular-stapled end-to-side anastomosis was performed. However, partial necrosis in the gastric tube developed to form refractory anastomotic fistula. Two months after the initial surgery, debridement and free jejunal transfer reconstruction with the pectoralis major muscle flap were performed. Although the postoperative course of the second surgery was uneventful, the patient complained of severe lower back pain and fever. The patient was diagnosed with pyogenic spondylodiscitis according to the results of the magnetic resonance imaging. Enterobacter cloacae were isolated from the arterial blood culture. Sensitive antibiotics were administered continuously, and the patient required to use a lumbar corset for 2 months. Subsequently, his physiological signs and symptoms had completely disappeared. Conclusion To the best of our knowledge, this case study is the first study that reported pyogenic spondylodiscitis of the lumbar spine, a complication of cervical anastomotic fistula after surgery for advanced esophageal cancer.

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