A Cut Above

      A 40-year-old man’s initial diagnoses did not explain all of his signs and symptoms—particularly when they took a calamitous turn. The patient, who had a history of L4-L5 laminectomy for lumbar radiculopathy, presented after 1 week of progressively worsening abdominal pain, difficulty walking, and fever. He had recently undergone rotator cuff surgery, which was complicated by a small wound abscess. His abdominal pain began as dull discomfort in the left inguinal region, spreading deep into the left hip and right inguinal region, with radiation to the back. The pain was accompanied by intermittent left-leg weakness that resolved spontaneously with positional changes.
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        • Darouiche R.O.
        Spinal epidural abscess.
        N Engl J Med. 2006; 355: 2012-2020
        • Davis D.P.
        • Wold R.M.
        • Patel R.J.
        • et al.
        The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess.
        J Emerg Med. 2004; 26: 285-291
        • Hagan G.
        • Adjogatse J.
        Spinal epidural abscess presenting as acute abdomen.
        Ann R Coll Surg Engl. 2004; 86: W15-W17
        • Lim E.C.
        • Seet R.C.
        Abdominal pain from a thoracic epidural abscess.
        J Gen Intern Med. 2006; 21: C8-C10
        • Bremer A.A.
        • Darouiche R.O.
        Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review.
        J Emerg Med. 2004; 26: 51-56
        • Flikweert E.R.
        • Postema R.R.
        • Briel J.W.
        • et al.
        Spinal epidural abscess presenting with abdominal pain.
        Eur J Pediatr Surg. 2002; 12: 141-143
        • Gellin B.G.
        • Weingarten K.
        • Gamache Jr, F.W.
        • et al.
        Epidural abscess.
        in: Scheld W.M. Whitley R.J. Durack D.T. Infections of the Central Nervous System. 2nd Ed. Lippincott-Raven Publishers, Philadelphia, PA1997: 507
        • Darouiche R.O.
        • Hamill R.J.
        • Greenberg S.B.
        • et al.
        Bacterial spinal epidural abscess.
        Medicine (Baltimore). 1992; 71: 369-385
        • Rigamonti D.
        • Liem L.
        • Wolf A.L.
        • et al.
        Epidural abscess in the cervical spine.
        Mt Sinai J Med. 1994; 61: 357-362
        • Danner R.L.
        • Hartman B.J.
        Update on spinal epidural abscess: 35 cases and review of the literature.
        Rev Infect Dis. 1987; 9: 265-274
        • Mooney R.P.
        • Hockberger R.S.
        Spinal epidural abscess: a rapidly progressive disease.
        Ann Emerg Med. 1987; 16: 1168-1170
        • Liem L.K.
        • Rigamonti D.
        • Wolf A.L.
        • et al.
        Thoracic epidural abscess.
        J Spinal Disord. 1994; 7: 449-454
        • Khanna R.K.
        • Malik G.M.
        • Rock J.P.
        • Rosenblum M.L.
        Spinal epidural abscess: evaluation of factors influencing outcome.
        Neurosurgery. 1996; 39: 958-964
        • Wheeler D.
        • Keiser P.
        • Rigamonti D.
        • Keay S.
        Medical management of spinal epidural abscesses: case report and review.
        Clin Infect Dis. 1992; 15: 22-27
        • Siddiq F.
        • Chowfin A.
        • Tight R.
        • et al.
        Medical vs. surgical management of spinal epidural abscess.
        Arch Intern Med. 2004; 164: 2409-2412