RESUMO
Background: Posttraumatic spinal cerebrospinal fluid leak (CSFL) without neurological deficit is a rare entity. Historically, the first-line treatment is a nonsurgical approach, which includes Trendelenburg positioning, carbonic anhydrase inhibitor (acetazolamide), and subarachnoid catheter, with a high successful rate of leak correction. However, in some cases, this first-line treatment could fail, being necessary the surgical approach. Case Description: A 23-year-old male with a recent stab wound to his lumbar region, complained of positional headache and fluid outflow through his wound. On physical examination, an active CSFL was detected without evidence of neurologic deficit. Imaging studies showed a CSF collection extending from the right L4 lamina to the subcutaneous tissue. CSF studies revealed bacterial meningitis. The treatment with carbonic anhydrase inhibitors, Trendelenburg position, lumbar subarachnoid catheter, and antibiotics was initiated. Failure of conservative measures prompted a surgical treatment to resolve the CSFL. Intraoperatively, a dura mater defect was identified, and an autologous paravertebral muscle flap was used for water-tight closure of the defect. The patient recovered without further complications and with CSFL resolution. Conclusion: Even though the nonsurgical approach is the first-line of treatment of traumatic CSFL cases, failures can occur. The evidence of a CSF trajectory in imaging studies could be a predictor of treatment failure of the nonsurgical treatment. The surgical treatment as second-line treatment has outstanding results regarding CSFL correction and should be considered when the prediction rate to nonsurgical approach failure is high.
RESUMO
La cistitis y la pielonefritis enfisematosa (PNE) son las infecciones del tracto urinario más frecuentes en mujeres, un 90 %, con factores de riesgo como diabetes y obstrucción. Son provocadas por la colonización de patógenos gramnegativos (E. Coli, Klebsiella), los cuales producen gas lo que genera un patrón clínico e imagenológico característico. Se presenta un caso en el que el paciente diagnosticado con pielonefritis enfisematosa no cuenta con las características habituales ni con los factores de riesgo frecuentes de esta entidad. Se destaca que un análisis correcto de las imágenes radiológicas y una evaluación clínica adecuada son fundamentales para su diagnóstico y apropiado tratamiento.vvvvvv
Cystitis and emphysematous pyelonephritis (EPN) are the most common urinary tract infections in women, 90%, with risk factors such as diabetes and obstruction. They are caused by the colonization of gram-negative pathogens (E. Coli, Klebsiella), which are capable of producing gas and cause the corresponding clinical and imaging pattern. We present a case in which the patient diagnosed with emphysematous pyelonephritis does not have the usual characteristics or frequent risk factors of this entity. It is emphasized that a correct analysis of the radiological images and an adequate clinical evaluation are fundamental for its diagnosis and appropriate treatment.