Spinal epidural abscess: a rare complication of ulcerative colitis after ileal pouch anal anastomosis

Mikio Kawamura, Toshimitsu Araki, Yoshiki Okita, Satoru Kondo, Takashi Ichikawa, Hiroyuki Fujikawa, Keiichi Uchida, Yasuhiko Mohri, Masato Kusunoki

Spinal epidural abscess is a rare condition with high morbidity and mortality, for which a delay in diagnosis and treatment can lead to irreversible neurologic deficit or even death. Although patients with spinal epidural abscess have systemic predisposing immunocompromised conditions, spinal intervention, or trauma, this condition has been reported as a result of perforation or fistulization arising from inflammatory bowel disease. We describe herein a rare case of spinal epidural abscess as a complication of ileal pouch anal anastomosis. A 37-year-old man who had previously undergone restorative proctocolectomy and ileal pouch anal anastomosis for ulcerative colitis presented with complaints of persistent low-grade fever and lumbago with unusual sensation in the lower legs. After evaluation by Gastrografin contrast radiography, computed tomography, and magnetic resonance imaging, he was diagnosed with a spinal epidural abscess extending from L5 to S1. In addition, the abscess communicated with the ileal pouch. He underwent surgical drainage of the abscess, excision of the fistula, and defunctioning ileostomy. Although a second operation for drainage was required for residual presacral abscess, there was no sign of recurrence of the spinal epidural abscess. He eventually was able to close his stoma. Although spinal epidural abscess is a rare complication, one should take this condition into account when patients complain of back pain or neurologic symptoms of the lower extremities, given the possibility of fistulous communication between the ileal pouch and spine.