Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Infections
Abstract number: 25147
PROXIMAL FEMORAL OSTEOMYELITIS FOLLOWING A RUPTURED SIGMOID
DIVERTICULITIS- A CASE REPORT AND REVIEW OF LITERATURE
Sitaram GIRI, Shiv Asish JAIN, Brian BANERJEE
Good Hope Hospital, Sutton Coldfield (UNITED KINGDOM)
Ruptured sigmoid diverticulitis may either present as peritonitis or a localised
abscess. These abscesses may track out of the pelvis along fascial planes or path of
least resistance. Spread can occur along blood vessels or muscles such as Iliopsoas,
pyriformis and oburator internus. Limb manifestations of perforated diverticular
disease can present a diagnostic challenge and need a high index of suspicion.
These are common in elderly patients. Extensive diverticulitis may sometimes
present only with extra peritoneal manifestation without any abdominal symptoms.We
present a case of a 67 year old male admitted with a history of lower back pain. Initial
investigations revealed a raised CRP. Clinical diagnosis of acute discitis was made
and urgent MRI was performed. MRI revealed no evidence of discitis. As he
continued to have temperature spikes and high CRP a pelvic CT-scan was
performed which revealed a severe diverticular disease and a small psoas collection.
This was aspirated followed by a course of antibiotics. Repeat CT-scan in 6 weeks
showed improved diverticular disease and no new collection.Presented around 6
months later with progressively worsening left groin pain. He had elevated CRP and
ESR. MRI scan revealed proximal femoral osteomyelitis with gross destruction of the
femoral head. He underwent a 2 stage uncemented THR. Peroperatively there was
granulation tissue in the acetabulum with advanced destruction of the femoral head.
He improved dramatically following the hip replacement and at the last review 6
months postoperative he was completely pain free with no evidence of persistent
infections
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