A case report of pyogenic spondylitis due to postoperative mesh infection after Robotic-assisted sacrocolpopexy

Abstract

　We report a case of pyogenic spondylitis due to postoperative mesh infection. The patient was a 59-year-old woman, gravida 3, para 2, who experienced menopause at age 50. Robotic-assisted sacrocolpopexy (RSC) was performed to diagnose pelvic organ prolapse classified as Stage 3 on the Pelvic Organ Quantification System. The removed uterus and fallopian tubes were collected in a bag and retrieved from the posterior vaginal canal. A 3-cm-wide mesh was then fixed to the anterior vaginal wall and the remaining cervix was secured to the sacral anterior longitudinal ligament with Ethibond®. The patient’s posterior vaginal fornix was continuously sutured with No. 1 Vicryl®. On postoperative days 19 and 24, bleeding occurred from the posterior vaginal fornix, and hemostasis was achieved by suturing. On postoperative day 40, the patient visited our hospital due to difficulty standing. She was diagnosed with pyogenic spondylitis by plain lumbar CT and MRI. After admission, she was treated with antibiotics. She developed severe numbness and pain in both lower limbs, and therefore laparoscopic mesh removal and abscess drainage were performed. Mesh removal was conducted from the cape angle to the sacral uterine ligament. The patient was discharged on postoperative day 53. If low back pain or neurological symptoms are observed after RSC, it is important to consider the possibility of pyogenic spondylitis and to evaluate radiological images accordingly. If pyogenic spondylitis is diagnosed, antibiotic treatment is required and mesh removal should be considered. Particular attention should be paid to infection when transvaginal procedures are performed during and after RSC.