Spinal subcutaneous nodules with cold abscesses commonly penetrate into the lungs, while penetration into hollow organs such as the esophagus, thoracic aorta, psoas abscess into the appendix, gallbladder, colon, and bladder is relatively rare. As a result, they are often misdiagnosed or mistaken for fistula diseases in clinical practice. This is highlighted for the reference of clinicians.

bubble_chart Etiology

Cold abscess is an important component of the pathology of subcutaneous nodes in the spine. When the bone lesion is in the acute phase and dominated by exudation, the abscess rapidly enlarges. At this time, the intracavitary pressure of the abscess also increases, causing it to rupture at weak points in the abscess wall. The caseous material, granulation tissue, and other pathological changes of subcutaneous nodes related to sexually transmitted diseases infiltrate and spread locally, penetrating adjacent organs to form abscess-organ fistulas.

1. Abscess-esophageal fistula The esophagus is relatively fixed and lacks a serosal layer, with a fragile muscular layer, making it susceptible to penetration by cold abscesses, though this is rare. Clinical reports include one case by Roaf (1959), two cases by Kyhenok (1972), and one case by the author (1980).

2. Abscess-colon or rectal fistula The ascending colon, descending colon, and rectum have limited mobility and are relatively fixed, adjacent to the psoas muscle abscess. Therefore, abscesses penetrating the colon are more common than those penetrating the highly mobile jejunum or ileum. Among Kyhenok’s 21 cases of abscesses penetrating hollow organs, 11 involved the colon. The author reported two cases involving the colon and one involving the rectum (1980).

Clinical manifestations: The nature of pus discharged from the fistula may have a fecal odor, and diagnosis can be made based on endoscopic examination, X-ray fistulography, and barium enema. Diagnosis: The nature of pus discharged from the fistula may have a fecal odor, and diagnosis can be made based on endoscopic examination, X-ray fistulography, and barium enema.

bubble_chart Treatment Measures

Preemptive subcutaneous node treatment, control of restriction and generation of suppurative infections, and other non-surgical treatments may lead to the cure of fresh abscess-organ fistulas. For those that do not heal over time, surgical intervention should be performed, with sensitive medications used during the perioperative period to treat suppurative infections. During the removal of spinal subcutaneous node lesions, surgical repair of hollow organ fistulas should be performed in the same seasonal epidemic period; alternatively, bone lesion surgery and organ fistula repair can be conducted in stages.