1176 Osteomyelitis as a Rare Complication of Delayed Diagnosis Spontaneous Bladder Perforation Post-Pelvic Radiotherapy: A Case Report

Spontaneous, delayed bladder perforation is a rare and serious complication of pelvic radiotherapy. Due to its rarity and late presentation, it usually causes further complications which warrant long inpatient stays before a diagnosis is made. Whilst most published cases highlight peritonitis as a common complication, our case has presented differently with pelvic osteomyelitis as another potential complication. Therefore, our objectives are to increase awareness about this presentation and highlight key aspects of quick diagnosis and management to prevent further complications. A 76-year-old gentleman, with background of Parkinson’s disease and pelvic radiotherapy for prostate cancer 11 years ago, presented with gradual onset suprapubic pain. He was managed initially with antibiotics and long-term urethral catheter for pelvic osteomyelitis secondary to urinary bladder perforation and then discharged. However, he was readmitted two weeks later with worsening osteomyelitis, delirium and sub-therapeutic Parkinson’s disease. Therefore, bilateral nephrostomies were inserted for acute kidney injury (AKI), further antibiotics given via a peripheral central catheter (PICC) and a prolonged recovery ensued. The clinical complications of delayed diagnosis of spontaneous bladder perforation in patients with history of pelvic radiotherapy are rare but difficult to manage. In addition, our case is the first one that highlights osteomyelitis as another potential complication and whilst there are different treatment modalities, the decision should be individualised.