Perforated retroperitoneal retrofascial sigmoid diverticulitis as a cause of osteomyelitis and septic necrosis of the acetabulum and proximal femur

A 44 year old man was treated during four months for a purulent inflammation of the left inguinal lymph nodes. Abdominal CT delineated left psoas abscess with osteomyelitis of the proximal part of the left femur. Barium enema and intravenous pyelography were nor- mal. Left inguinal incision with opening of the retroperi- toneal space was performed and approximately 1 L of pus was evacuated. The patient also complained of pain in the left hip region with painful movements. Reincisions were made three times and finally pus was found in the hip joint with osteomyelitis of the femoral head of unknown cause. Garamycin and metronidazole were administered according to the antibiogram (Bacteroides spp., E. coli and S. rubidaea). In spite of therapy the condition worsened, with development of sepsis. Patient was sent to the Department of Surgery at the Clinical Hospital Center Zagreb.