Delayed Diagnosis of Pyogenic Spondylitis After Impalement by Steel Rods: Case Report.

Penetrating spine injuries associated with abdominal and thoracic injuries caused by steel bars are rare. We report a unique case of delayed spinal spondylitis after penetrating abdominal and thoracic injuries from multiple steel bars. A 65-year-old man fell from a 20-m high scaffolding onto vertical steel bars. Steel bars penetrated his scrotum, abdomen, thoracic cavity, thigh, calf, and left ankle. At the accident scene, a fellow worker removed multiple penetrating bars. The first operation included repairs to the liver, diaphragm, transverse colon, sigmoid colon, jejunum, scrotum, and the pelvic wound, as well as open reduction and internal fixation of the left ankle. In a second operation, surgeons resected the sigmoid colon with anastomosis, and then sutured and debrided the peritoneum, mesentery, and the right thigh and calf wounds. The patient complained of anorexia and melena a month and a half after the trauma. Chest computed tomography 57 days after the trauma demonstrated pyogenic spondylitis in the thoracic spine. Culture of a perivertebral abscess 2 months after trauma revealed Pseudomonas aeruginosa. Antibiotic treatment resolved the pyogenic spondylitis. High clinical suspicion and awareness of delayed pyogenic spondylitis support early diagnosis and improve outcomes when appropriate treatment is given.