Spinal epidural abscess -- a rare complication of inflammatory bowel disease

Abstract

Spinal epidural abscess is an uncommon but highly morbid illness. While it usually afflicts older, immunocompromised patients, this condition has been reported as a result of intestinal perforation in the setting of inflammatory bowel disease. Two cases of spinal epidural abscess in patients with inflammatory bowel disease are reported: one in a patient with Crohn's disease and one in a patient with ulcerative colitis after restorative proctocolectomy.

Figure 1)

A sagittal magnetic resonance imaging scan of the lumbar spine, showing epidural abscesses from L5 to S3 (arrows). Soft tissue mass is seen in the presacral space corresponding to the abscesses

Figure 2)

A Axial computed tomography scan at the level of L5 to S1 disc space, showing multiple bilateral paraspinal abscesses (arrow) and ‘ring enhancing’ inflammatory masses in the epidural, and both right and left sacral foramina (open arrowheads). B Axial computed tomography scan of the lower pelvis, showing a thickened distal ileum tethered toward the inflammatory presacral abscess (arrow)

Figure 3)

A Sagittal computed tomography scan of the ileal pouch (black arrow), showing a leak from the posterior aspect of the ileoanal pouch (black arrowhead), with a thin layer of presacral abscesses (white arrows). B Sagittal computed tomography scan image to the left of the midline, showing pockets of gas with an ill-defined abscess in the intervertebral foramen in the epidural space (arrow)