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Acute on chronic back pain as the presentation of an occult foreign body bowel perforation with resultant epidural abscess, osteomyelitis and sepsis
  1. Jeff A Guthrie1,
  2. Michael Fazio2,
  3. Todd Anderson3 and
  4. Christine Carroll3
  1. 1Radiology, Bayne-Jones Army Community Hospital, Fort Polk, Louisiana, USA
  2. 2Radiology, Walter Reed Army Medical Center, Bethesda, Maryland, USA
  3. 3Emergency, Bayne-Jones ACH, Fort Polk, Louisiana, USA
  1. Correspondence to Dr Jeff A Guthrie; jeffaguthrie{at}


A 29-year-old male paratrooper presented to multiple emergency departments (EDs) and his primary provider multiple times over sequential days. Each time, the patient received the same diagnosis of acute on chronic back pain. The patient was treated conservatively and routine MRI of the lumbar spine was performed 5 days after the last visit. It revealed a lesion occupying nearly all the visualised portion of the spinal canal. The patient was immediately called back for further imaging. The patient was then diagnosed with a foreign body perforating the rectosigmoid colon, an epidural abscess and pelvic osteomyelitis. The patient was immediately taken to the ED where he was found to be septic. The foreign body was surgically removed and determined to be a swallowed toothpick. Urgent surgical decompression of epidural space was also performed. The patient then underwent a prolonged but near complete recovery.

  • radiology
  • back pain
  • neuroimaging
  • infection (gastroenterology)

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  • Contributors Supervised by MF. Patient was under the care of JAG and TA. Report was written by JAG, MF, TA and CC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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