Unusual presentation of an anterior sacral meningocele: magnetic resonance imaging, multidetector computed tomography, and fistulography findings of bacterial meningitis secondary to a rectothecal fistula

An anterior sacral meningocele, a rare congenital anomaly, manifested in a previously healthy 44-year-old woman with findings of meningitis, including headache, vomiting, unconsciousness, and fever. Nontraumatic pneumocephalus, tetraventricular hydrocephalus, fluid-fluid level at the lateral ventric...

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Bibliographic Details
Published in:Japanese journal of radiology 2011-08, Vol.29 (7), p.528-531
Main Authors: Koksal, Ali, Canyigit, Murat, Kara, Taylan, Ulus, Aykan, Gokbayir, Hakan, Sarisahin, Murat
Format: Article
Language:English
Subjects:
Abnormalities, Multiple - diagnosis
Abnormalities, Multiple - diagnostic imaging
Abnormalities, Multiple - etiology
Abnormalities, Multiple - surgery
Adult
Anti-Bacterial Agents - therapeutic use
Antibiotics
Arachnoiditis
Case Report
Catheters
Computed tomography
Congenital defects
Contrast Media
Diagnosis, Differential
Drainage
Escherichia coli
Female
Fever
Headache
Humans
Hydrocephalus
Imaging
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Medicine
Medicine & Public Health
Meninges
Meningitis
Meningitis, Bacterial - complications
Meningitis, Bacterial - diagnosis
Meningitis, Bacterial - drug therapy
Meningocele - diagnosis
Meningocele - diagnostic imaging
Meningocele - etiology
Meningocele - surgery
Multidetector Computed Tomography - methods
Nuclear Medicine
Radiology
Radiotherapy
Rectal Fistula - complications
Rectal Fistula - diagnosis
Rectal Fistula - surgery
Sacrococcygeal Region - abnormalities
Sacrococcygeal Region - diagnostic imaging
Sacrococcygeal Region - surgery
Sacrum
Surgery
Surgical Flaps
Ventricle (lateral)
Vomiting
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Description
Summary:An anterior sacral meningocele, a rare congenital anomaly, manifested in a previously healthy 44-year-old woman with findings of meningitis, including headache, vomiting, unconsciousness, and fever. Nontraumatic pneumocephalus, tetraventricular hydrocephalus, fluid-fluid level at the lateral ventricles, and pial enhancement were observed on multidetector computed tomography. A ventricular drainage catheter was placed to decompress the hydrocephalus, and drainage was performed urgently. Escherichia coli was isolated from the drainage material. Whole-spine magnetic resonance imaging and fistulography were undertaken on the third day after admission to evaluate for anal and urinary incontinence and pareses of both upper and lower extremities. Spinal arachnoiditis, tethered cord, dysgenesis of the sacrum, and a rectothecal fistula were demonstrated. Specific antibiotic treatment and surgery for fistula tract excision were performed.
ISSN:1867-1071
1867-108X
DOI:10.1007/s11604-011-0582-x