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Osteomyelitis of the lumbar vertebral body following drainage of a subdiaphragmatic abscess

1960; Elsevier BV; Volume: 99; Issue: 3 Linguagem: Inglês

10.1016/0002-9610(60)90184-7

1879-1883

Richard F. Slager,

Diagnosis and treatment of tuberculosis

P ATIENT H. J., a fifty-nine year old engineer, had been under treatment for a peptic ulcer for ten years. His Iast severe attack had occurred seven weeks prior to admisslon. During this attack severe generalized abdomina1 pain deveIoped. Radiographs in a Iocal hospital demonstrated peritonitis. When admitted, he compIained of pain in the right upper quadrant of the abdomen as we11 as in the spinous processes of the upper Iumbar vertebra. He aIso compIained of shortness of breath and nausea. X-ray fiIms demonstrated ateIectasis of the right Iower Iobe and a subdiaphragmatic abscess as we11 as a fistuIa from the duodenum to the abscess. The abscess was drained. The condition of the chest, the temperature and the patient’s weII-being returned to normal. The cuItures were sensitive to ChoIoromycetin.@ He was discharged from the hospita1 with a de Pezzer catheter in the abscess cavity and instructions to take 2 gm. of ChoIoromycetin daiIy. The pain in the Iumbar spinous process was expIained by osteoarthritis since roentgenograms demonstrated osteophytosis of many of the vertebra1 bodies. (Fig. I.) One month folIowing discharge, the patient returned for foIIow-up examination and was asymptomatic. His duodenum was scarred but he had improved subjectiveIy. ChIoromycetin was therefore discontinued. Five weeks Iater he was admitted as an emergency. He complained of a severe pain in the spinous processes of LI through L4. The pain had been increasing for two weeks and required narcotics for reIief.