A spinal epidural abscess complicating an intrauterine contraceptive device

Hip prosthesis infection related to an unchecked intrauterine contraceptive device: a case report

Intrauterine devices (IUD) used for contraception can be the source of local infections or can migrate, which justifies regular checking recommendations and limitations around the implantation period. To our knowledge, bone and joint infections related to an infected IUD have not been described in the scientific literature. This paper reports on a case of the repeated infection of a total hip prosthesis related to an infected IUD that had been forgotten after being implanted 34years previously. The arthroplasty infection revealed itself through dislocation of a dual mobility cup. Commensal bacteria that colonize the female genital tract (Streptococcus agalactiae) were identified at the site of hip arthroplasty. This led to the discovery of the IUD that was infected by the same bacterium. Despite lavage of the non-loosened arthroplasty, removal of the IUD and 2months of antibiotic treatment, the dislocation recurred and the prosthesis was again infected with the same microorganism 4months later. This recurrence of the infection, with persistence of a uterine abscess containing the same bacterium, was treated with repeated lavage of the joint, total hysterectomy and antibiotics treatment. The infection had resolved when followed-up 3years later. The occurrence of a bone and joint infection with this type of bacterium should trigger the evaluation of a possible IUD infection.

[Spinal epidural abscess-an interdisciplinary emergency.]

Introduction Spinal epidural abscess is a rare cause of neurological disability, which is frequently, preceded by local spinal pain. There are only a few case series in the literature and the prognosis for this disease has not improved significantly over the past 50 years. Patients and methods Seven patients were treated neurosurgically with laminectomy and abscess drainage for spinal epidural abscesses from 1991 to 1994. Results All but one patient had several weeks of local spinal pain (mainly after minor trauma), immunosuppression, and all exhibited excessively high blood sedimentation rates. On admission they presented either with hemiparesis or with signs of complete spinal cord transection. Since preoperative neuronal damage persisted too long, only 3 patients showed slight improvement of their neurological functions postoperatively. Conclusion A spinal epidural abscess is a rare, but devastating interdisciplinary emergency, which poses no operative technical problem to the neurosurgeon. Poor results can be avoided by carefully taken individual histories, which are dominated by long-standing and significant local spinal pain in most cases. The pre-operative neurological status is crucial for the long-term outcome. Elevated blood sedimentation rates in conjunction with local pain of the vertebral column should direct attention to the possibility of an epidural abscess. Magnetic resonance imaging is the radiological technique of choice for establishment of the diagnosis. Conventional X-rays are of no value for early diagnosis because neurological signs and symptoms precede bony changes of the vertebrae.

Acute spinal epidural empyema. Observations from seven cases

Seven cases with an acute epidural spinal empyema are presented. The best results are observed in cases with early treatment. Since this rare condition is not widely known and swift diagnosis and treatment is imperative, it is stressed that immediate referral of the patient with back pain and any signs of infection in addition to commencing neurological abnormalities to a neurological unit for myelography can be vital or can at least reduce the risk of permanent paraplegia.

Epidural abscess complicating Swenson procedure: a case report and a review of the literature

A case is reported in which an anastomotic leak following the Swenson procedure for Hirschsprung's disease was complicated by the development of a pelvic abscess that communicated freely with the epidural space. The child presented with signs and symptoms of an epidural abscess, but his myelogram was normal. The diagnosis was made by urografin enema. The child was treated by defunctioning colostomy and drainage of the pelvic abscess by enlarging the defect at the anastomosis site digitally. The epidural space drained freely to the pelvis and therefore laminectomy was not required. The possible etiology of such a communication is discussed.