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Unusual presentation of more common disease/injury
Small bowel obstruction due to a spinal implant: a previously unreported cause of a common surgical presentation
  1. R G Clarke,
  2. D May,
  3. F Noble,
  4. T Bryant,
  5. P H Nichols
  1. Colorectal E Level West Wing, Southampton General Hospital, Southampton, UK
  1. Correspondence to R G Clarke, roboclarke{at}msn.com

https://doi.org/10.1136/bcr.01.2010.2683

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    Background

    Bowel obstruction is a common surgical emergency. If a patient fails to settle with conservative management or demonstrates signs of peritonitis an operation is indicated.1 As part of the assessment, radiological investigation, as well as history and examination, can be paramount in identifying the cause. We describe a rare and previously unreported aetiology for small bowel obstruction due to fistulation of a spinal implant into the bowel lumen.

    Case presentation

    A 72-year-old woman with a past history of ulcerative colitis and long-term steroid therapy underwent subtotal colectomy and end ileostomy 11 years previously. Over the preceding 12 months she had experienced multiple episodes of subacute bowel obstruction and abdominal pain. Investigations with plain radiographs and CT had failed to identify a cause, although adhesions were suspected as the most likely cause. The patient presented with a 4-day history of abdominal distension, nausea and vomiting, with decreased output from her ileostomy. Past surgical history consisted of multiple spinal operations, including an L1-4 spinal fusion 9 years …

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.