ABSTRACT
A rare and possibly fatal infection of the bone called emphysematous osteomyelitis (EO) is caused by the presence of intraosseous gas due to gas-forming organisms. Common gas-producing organisms are in the Enterobacteriaceae family or are anaerobes. This gas within bones is most frequently detected using computed tomography (CT) imaging, and prompt diagnosis is important due to the high mortality rate. We present a 76-year-old male who complained of altered mental status, right upper and lower extremity weakness, and lower back pain. The MRI of the lumbar spine showed moderate edema in L3 and L4, with fluid in L3-L4 and L4-L5 concerning discitis/osteomyelitis. A CT-guided biopsy of L3/L4 was then performed by interventional radiology, revealing air present in the L3 and L4 vertebral bodies. Bone cultures from the L3 and L4 vertebra were later positive for E. coli that was susceptible to all tested antibiotics, and this was consistent with a diagnosis of vertebral EO. The infectious disease team recommended a six-week course of intravenous ceftriaxone. During the patient's hospital stay, he also developed a septic right knee joint positive for E. coli, alongwith the concurrent vertebral EO.
ABSTRACT
BACKGROUND: Colonic manometry (CM) is a diagnostic procedure utilized in the evaluation of intractable constipation and involves endoscopic insertion of a manometry catheter with the tip placed in the cecum. Difficulty in advancing the colonic manometry catheter to the right colon and/or distal displacement of the catheter after appropriate placement can result in partial evaluation of the colon. Our study aimed to assess the value of limited left CM in identifying motility disorders. METHODS: We evaluated CM studies conducted at a tertiary pediatric center (2019-2022). Abnormal CM studies with catheter tips located in the cecum or ascending colon were included. KEY RESULTS: Of 161 CM studied, 68 with abnormal CM studies met inclusion criteria (29 [42.7%] females, median age 10.3 years). Pan-colonic dysmotility was noted in 29 (42.7%) studies and segmental dysmotility in 39 (57.4%) studies. Dysmotility of the descending and/or sigmoid colon was the most common segmental dysmotility (30, 76.9%). Isolated dysmotility of the ascending colon was noted only in patients with a cecostomy (6/13, 46.2%). The diagnostic sensitivity for dysmotility by left CM was 91.2%, which increased to 100% when excluding patients with cecostomy. CONCLUSIONS AND INFERENCES: Left CM is a valuable and sensitive diagnostic tool for identifying abnormal colonic motility in most pediatric patients with constipation without cecostomy. Our study results provide reassurance when the manometry catheter becomes dislodged from the cecum and moves distally. Those with cecostomy have a high prevalence of dysmotility in the ascending colon and need a complete CM to identify it.