Delayed presentation of urinoma mimicking spondylodiscitis secondary to ureteric injury following carrot stick fracture in ankylosing spondylitis

Soundararajan, Dilip Chand Raja; Maheswaran, Anupama; Kumarasamy, Dinesh; Shetty, Ajoy Prasad; Kanna, Rishi Mugesh; Rajasekaran, S.

doi:10.1007/s00586-020-06408-5

Cited by 1 publication

(2 citation statements)

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“…CT and MRI studies showed ureteric leak into the psoas muscle with resultant abscess formation. [ 10 ] Other pelvic malignancies and their treatment regimens have been linked with urinary fistulas and subsequent osteomyelitis (i.e., of the pubic bone in association with pubosymphyseal urinary fistula after prostate cancer[ 3 - 5 , 9 ] and/or cervical cancer[ 6 , 8 ] treatments).…”

Section: Discussionmentioning

confidence: 99%

“…[ 12 ] Ureteral fistulation can lead to intra-abdominal sepsis, renal failure, and, rarely, vertebral osteomyelitis/spinal abscess. [ 1 , 2 , 10 ] Here, we describe a 76-year-old female who developed a fistulation between her right ureter and the L3 vertebral body secondary to L2-L3/L3-L4 discitis/osteomyelitis and psoas abscess, leading to paraparesis warranting surgical debridement 17 months following stent placement for endometrial adenocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

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Spinal osteomyelitis and epidural abscess caused by ureterovertebral fistula: A case report

Blitz

Chua

Klinger

et al. 2022

Surgical Neurology International

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Background: Ureteral fistulas are abnormal connections between the ureters and other organs. Maintaining a high index of suspicion is important because they can precipitate dangerous complications such as sepsis and renal failure. Connections to a vertebral body have only been documented in the setting of trauma. Here, we present a 67-year-old female with a ureterovertebral fistula extending into the L3 vertebral body. Case Description: A 67-year-old female with a history of endometrial adenocarcinoma underwent surgery and radiation therapy complicated by a right ureteral obstruction requiring stent placement. Five months later, she developed back pain and MR-documented L2-L4 level osteomyelitis/discitis with a psoas phlegmon/abscess, which required drainage. A fistula was later identified between the right ureter and the psoas phlegmon. Despite percutaneous nephrostomy placement and aggressive IV antibiotic treatment, she was readmitted for persistent signs of infection over the next few months during which time she was repeatedly and unsuccessfully treated with multiple antibiotics. Sixteen months following her original stent placement, she developed right leg weakness and urinary incontinence attributed to the MR-documented ureteropsoas fistula extending into the L3 vertebral body. Following a nephrectomy with ureteral ligation, an L3 anterior corpectomy with interbody fusion for discitis at both L2-L3 and L3-L4, and an L1-L5 posterolateral fusion, she was discharged to a rehabilitation center. Conclusion: In patients with recurrent sepsis, osteomyelitis/discitis, or psoas abscess of unknown origin or who have a significant history (e.g., pelvic malignancy, radiation, and instrumentation), it is important to consider urodynamic testing to look for a ureteral leak or fistula.

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