Chronic esophageal fistula as a rare cause of secondary osteomyelitis of the thoracic spine

Abstract

Infectious diseases affecting the spine are inflammatory destructive diseases that involved the organ and its structural elements as a result of infection by hematogenic, lymphogenic, or contact pathways, including may be a complication of surgical intervention. In arriving at an accurate diagnosis, it is extremely important to evaluate the anamnesis, the clinical picture, as well as the data of laboratory studies and radiation diagnostics in the aggregate. This article presents a clinical case with the development of secondary ThVII–ThVIII vertebral spondylitis due to esophageal fistula. At the initial diagnosis, spondylitis was associated with spinal anesthesia performed six months prior to onset of the disease, as there was a fistulous defect on the skin in the lumbar region. Consequently, surgical interventions were performed three times in a surgical hospital at the place of residence. The data from the endoscopic examination, as well as the patient’s complaints regarding the relationship between meals, the appearance of pain, and the nature of the discharge from the fistula were not taken into account by doctors initially. With the help of an additional examination, including computed tomography of the esophagus with oral contrast and computed tomography fistulography, the main diagnosis was esophageal fistula. Thoracic spondylitis was only a secondary complication. Thus, the final diagnosis of back pain and fistula in the lumbar region should be formulated after differential diagnosis with alternative diseases of the spine.

Keywords

• osteomyelitis
• spondylitis
• esophageal fistula