Thoracoscopic Drainage of Para-Vertebral Abscess - Report of Two Cases

Abstract

Tuberculosis of the spine is common in tropical countries like Bangladesh and it is the most common site of skeletal
tuberculosis as a whole. In addition to the anti-tubercular chemotherapy, paravertebral abscess often require surgical
decompression. Surgical intervention for the thoracic region needs formal thoracotomy which involves a very long
incision over the chest. In this regards, thoracoscopic drainage would have been a good option. Two patients (one 53
years old female and other 20 years old male) with para- vertebral abscess with compression and collapse of vertebral
bodies resulting cord compression presented with neurological symptoms underwent video assisted thoracoscopic
drainage with biopsy from the abscess wall using a standard laparoscope (as thoracoscope) at the Bangabandhu
Sheikh Mujib Medical University (BSMMU), and a private hospital in Dhaka. The patients were fed on 1st post operative
day and antituberculer chemotheraphy was continued. Post-operative period was uneventful and the patients were
discharged on 8th post operative day with antituberculer chemotheraphy. There was a gradual improvement of neurological
symptoms of lower limbs. Till date the 1st and 2nd patient were followed-up for a period of 18 and 12 months respectively.
The condition of both patients improved gradually with no neurological deficit. To the best of our knowledge, there was
no previous report of thoracoscopic drainage of para-vertebral abscess from Bangladesh. So this is the 1st report in our
country. Thoracoscopic drainage of para-vertebral abscess appears to be a technically feasible, patient friendly modality
of treatment for the spinal tuberculosis in experienced hand with excellent cosmetic out come.

Key words: Thoracoscopic drainage; paravertebral abscess

DOI: 10.3329/bsmmuj.v3i1.5513

BSMMU J 2010; 3(1): 35-39