Sacral osteomyelitis after laparoscopic sacral colpopexy performed after a recent dental extraction: a case report.
*Bacteroides fragilis; Aged; Bacteroides Infections/*etiology; Discitis/etiology; Female; Humans; Laparoscopy/methods; Osteomyelitis/*etiology; Pelvic Organ Prolapse/surgery; Postoperative Complications/etiology; Sacrum/*surgery; Tooth Extraction/*adverse effects; Vagina/surgery
BACKGROUND: Sacral osteomyelitis and subsequent discitis is a rare complication after laparoscopic sacral colpopexy to repair apical vaginal prolapse. CASE: We present a patient who developed Bacteroides fragilis sacral osteomyelitis and discitis after laparoscopic sacrocolpopexy with synthetic monofilament mesh and sacral titanium coil fixation. The patient had undergone dental extraction of 3 infected teeth approximately 2 weeks before sacrocolpopexy for stage IV apical vaginal prolapse. Computed tomography and magnetic resonance imaging (MRI) confirmed sacral osteomyelitis and discitis along with Bacteroides fragilis bacteremia approximately a week and a half after the original surgery. The patient was followed up with serial MRIs of the spine which revealed degeneration at the sacral promontory. The patient underwent successful removal of the entire mesh and sacral titanium coils with resolution of her symptoms. Follow-up MRI of the spine revealed resolution of her sacral osteomyelitis. CONCLUSIONS: Sacral osteomyelitis is a rare complication after sacrocolpopexy for pelvic organ prolapse repair. There should be a high index of suspicion for patients presenting with disproportionate low back pain and vague symptoms after surgery. Recent oral surgery may increase the risk of bacteremia and subsequent infectious morbidity after sacrocolpopexy with the use of synthetic mesh for prolapse repair.
Apostolis Costas A; Heiselman Cassandra
Female pelvic medicine & reconstructive surgery
2014
2014-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/SPV.0000000000000092" target="_blank" rel="noreferrer noopener">10.1097/SPV.0000000000000092</a>
Effect of Pregnancy and Delivery on Cytokine Expression in a Mouse Model of Pelvic Organ Prolapse.
Amino Acid Oxidoreductases/*genetics/metabolism; Animal; Animals; Chemokine CCL7/genetics/metabolism; Chemokine CXCL12/genetics/metabolism; Delivery; Female; Humans; Knockout; Mice; Models; Obstetric/*adverse effects/methods; Pelvic Organ Prolapse/*genetics/metabolism/pathology; Pregnancy; Reverse Transcriptase Polymerase Chain Reaction; Urethra/metabolism; Urinary Bladder/metabolism; Vagina/metabolism
OBJECTIVES: The aim of this study was to determine the effect of pregnancy and delivery mode on cytokine expression in the pelvic organs and serum of lysyl oxidase like-1 knockout (LOXL1 KO) mice, which develop pelvic organ prolapse after delivery. METHODS: Bladder, urethra, vagina, rectum, and blood were harvested from female LOXL1 KO mice during pregnancy, after vaginal or cesarean delivery, and from sham cesarean and unmanipulated controls. Pelvic organs and blood were also harvested from pregnant and vaginally delivered wild-type (WT) mice and from unmanipulated female virgin WT controls. Specimens were assessed using quantitative real-time reverse transcription polymerase chain reaction and/or enzyme-linked immunosorbent assay. RESULTS: Both CXCL12 and CCL7 mRNA were significantly up-regulated in the vagina, urethra, bladder, and rectum of pregnant LOXL1 KO mice compared with pregnant WT mice, suggesting systemic dysregulation of both of these cytokines in LOXL1 KO mice as a response to pregnancy.The differences in cytokine expression between LOXL1 KO and WT mice in pregnancy persisted after vaginal delivery. CCL7 gene expression increases faster and to a greater extent in LOXL1 KO mice, translating to longer lasting increases in CCL7 in serum of LOXL1 KO mice after vaginal delivery, compared with pregnant mice. CONCLUSIONS: Lysyl oxidase like-1 KO mice have an increased cytokine response to pregnancy perhaps because they are less able to reform and re-cross-link stretched elastin to accommodate pups, and this resultant tissue stretches during pregnancy. The up-regulation of CCL7 after delivery could provide an indicator of level of childbirth injury, to which the urethra and vagina seem to be particularly vulnerable.
Couri Bruna M; Lenis Andrew T; Borazjani Ali; Balog Brian M; Kuang Mei; Butler Robert S; Penn Marc S; Damaser Margot S
Female pelvic medicine & reconstructive surgery
2017
2017-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/SPV.0000000000000394" target="_blank" rel="noreferrer noopener">10.1097/SPV.0000000000000394</a>