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Case Reports
. 2024 Aug 22;16(8):e67536.
doi: 10.7759/cureus.67536. eCollection 2024 Aug.

Successful Treatment of Complicated Pyogenic Spondylitis Due to Advanced Rectosigmoid Cancer Utilizing Vigorous Antibiotic Therapy and Minimally Invasive Robotic Colorectal Surgery: A Case Report

Keita Tanaka  1 , Takahisa Fujikawa  1 , Daibo Kojima  1 , Keiji Nagata  1 , Suguru Hasegawa  2
Affiliations
Case Reports

Successful Treatment of Complicated Pyogenic Spondylitis Due to Advanced Rectosigmoid Cancer Utilizing Vigorous Antibiotic Therapy and Minimally Invasive Robotic Colorectal Surgery: A Case Report

Keita Tanaka et al. Cureus. .

Abstract

We report a case of rectosigmoid cancer complicated by pyogenic spondylitis. The patient was a 71-year-old man who had anemia and back pain. Endoscopy revealed a rectosigmoid tumor, confirmed to be well-differentiated adenocarcinoma. Imaging indicated rectosigmoid cancer with pyogenic spondylitis at the L1 vertebra. We performed radical resection (robotic-assisted Hartmann's procedure) after controlling the inflammation caused by pyogenic spondylitis. Colon cancer complicated by pyogenic spondylitis is rare. Here, we describe the mechanisms of this infection and treatment strategies along with a review of the literature.

Keywords: batson venous plexus; colorectal cancer; minimally invasive surgery; pyogenic spondylitis; robotic colorectal surgery.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative endoscopy, contrast-enhanced CT, and MRI findings
(A) Endoscopic findings revealed a circumferential tumor in the rectosigmoid. (B, C) Contrast-enhanced CT revealed wall thickening in the rectosigmoid, which was in contact with the small intestine and bladder (yellow dotted area). Fluid collection was observed on the left side of the L1 vertebral body (yellow arrows). (D) T2-weighted MRI revealed a high-intensity area on the L1 and L2 vertebral bodies, as well as the left side of the L1 vertebral body. (yellow dotted area).
Figure 2
Figure 2. Abscess drainage findings and intraoperative findings during colostomy
(A) Abscess drainage on the left side of the L1 vertebral body in the prone position. (B, C) The tumor was attached to the ileum and bladder.
Figure 3
Figure 3. Operative findings during robot-assisted Hartmann’s procedure
(A) The infiltrated part of the ileum was resected. (B, C) Findings around the bladder. There was no macroscopically obvious bladder invasion, and the bladder was preserved. (D) Rectal dissection.
Figure 4
Figure 4. Clinical course of the current patient
After abscess drainage, colostomy, and vigorous antibiotic therapy, Hartmann’s procedure was performed. Postoperatively, the patient's back pain dramatically improved, and the CRP level also improved. The patient was discharged on the thirty-third postoperative day without worsening back pain. CMZ: cefmetazole; MEPM: meropenem; CTRX: ceftriaxone; MINO: minocycline; CRP: C-reactive protein; NRS: numerical rating scale; POD: postoperative day
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