Int Urogynecol J (2008) 19:1311–1313 DOI 10.1007/s00192-008-0599-6 CASE REPORT Serious complication 1 year after sacrospinous ligament fixation Violet J. Faber & Huub C. van der Vaart & Ben G. F. Heggelman & Steven E. Schraffordt Koops Received: 29 September 2007 / Accepted: 24 February 2008 / Published online: 10 April 2008 # The Author(s) 2008 Abstract Myositis of the gluteal region caused by group A streptococci 1 year after a sacrospinous ligament fixation was recognised as a serious complication of this procedure. Most likely, the infection was spread to the gluteal region through a port d’entree caused by vaginal atrophy, via the non-resorbable sutures. The patient was treated successfully with antibiotics intravenous and local estrogens. Keywords Sacrospinous ligament fixation . Prolapse . Myositis . Group A streptococci Introduction Sacrospinous ligament fixation (SSLF) with uterine preser- vation is a safe and effective procedure for the treatment of uterovaginal prolapse [1, 2]. Known complications of a sacrospinous fixation with or without uterine preservation for the treatment of pelvic organ prolapse or vaginal vault V. J. Faber (*) : S. E. Schraffordt Koops Department of Obstetrics and Gynecology, Meander Medical Centre, Ringweg Randenbroek 110, 3816 CP Amersfoort, The Netherlands e-mail: vjfaber@gmail.com H. C. van der Vaart Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands B. G. F. Heggelman Department of Radiology, Meander Medical Centre, Amersfoort, The Netherlands prolapse are haemorrhage, cystitis, perforation of the bladder, rectum or small bowel, rectovaginal fistula, post-operative pain of the gluteal region and nerve injury [3, 4, 5]. Case A 76-year-old woman without any comorbidity, para 4, presented to our hospital at the emergency ward with fever for 4 days, pain in the right buttock and lower abdomen. She also had noticed vaginal discharge for a few weeks. At the time of admission, she was sexually active. One year ago, she underwent an unilateral sacrospinous fixation with uterine preservation as well as an anterior and posterior colporrhaphy for a stage 2 descensus uteri and a stage 3 cystocele (prolapse according to Baden Walker classification). During this procedure, two non-resorbable monofilament Prolene sutures were placed through the sacrospinous ligament and through the cervix. There had been no intraoperative complication, and following the protocol, the vagina had been prepped with Betadine®, and pre-operatively, the patient had received 1 g of cefazolin and 500 mg of metronidazole intravenous. At the time of admission, the patient had a temperature of 39°C, and a quick shallow breathing was seen. Her right buttock was very painful and indurated; the abdomen was soft and non-tender. Blood results showed a white blood cell count of 25.2× 109/l and a C-reactive protein of 284 mg/l. The ultrasound of the right hip, made because of the pain in the right buttock and the signs of infection, showed an echodensity suspect for a myositis or fasciitis of the gluteus region on the right side. The magnetic resonance imaging performed supplementary, suspected myositis of the gluteus region extended or originated from the cervix (Fig. 1). It showed a fistula and scar tissue between the posterior DO00599; No of Pages