Spondylodiscitis and epidural abscess caused by oesophageal perforation due to a metallic stent
Past history of inoperable oesophageal carcinoma (SCC) treated with overlapping oesophageal stents. Now severe interscapular pain for weeks, with low grade fever, CRP of 150 and WCC of 18,000. CT request states ? metastatic lesion to the spine.
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At the proximal end of the stent there is perforation of the oesophageal wall with development of a paraspinal mass containing gas (indicating abscess) eroding the T2 and 3 vertebral bodies (and adjacent rib heads) via the disc space to enter the epidural space as evidenced by the presence of gas bubbles.
Localised perforation of the oesophagus due to a metallic stent is a well recognised complication. This is usually complicated by a mediastinum or paravertebral abscess as in this case often containing very unusual upper GIT organisms (may be multiple). The infection is often indolent but ultimately progressive and in this case has extended into the vertebral column via the disc space causing the bodies to collapse. Infection has then entered the epidural space. This usually has a fateful outcome.