Presacral Neuroenteric Fistula in a Newborn Presenting With an Epidural Abscess: Case Report and Review of the Literature

Abstract

ABSTRACT. We describe a newborn infant (<24 hours of age) who presented with mild swelling on the back and buttocks attributable to a neuroenteric fistula complicated by an epidural parasacral abscess infected with mixed coliforms. Epidural abscesses in infancy are extremely rare, and one has not been observed previously in the newborn period. The infant was surprisingly mildly affected. Prompt intervention led to an excellent outcome. Coliforms may colonize the infant gut in <24 hours, even in the developed world. Unexplained swellings on the backs of infants should lead to a search for underlying malformations and an early surgical review, which is best conducted with a combined pediatric surgical and neurosurgical approach. N euroenteric cysts (fistulas) are rare, with Ͻ30 cases being described in the pediatric literature. Epidural abscesses presenting in infancy are even rarer, with the youngest patient reported being 20 days of age. 1 An epidural abscess complicating a congenital neuroenteric cyst appears not to have been reported previously. CASE REPORTA Ͻ1-day-old boy was admitted to the neonatal unit at a peripheral hospital with irritability, lethargy, and poor feeding. He had been delivered at 42 weeks of gestation through normal vaginal delivery and weighed 3250 g. His mother had an older healthy child and had remained in good health during this pregnancy. She admitted to smoking cigarettes and occasionally drinking alcoholic drinks. Results of ultrasound scanning performed in the first trimester had been reported as normal and consistent with dates. The infant's condition at birth was excellent, and he was allowed home, breastfeeding successfully, at 12 hours of age. In the examination, the infant was mildly jaundiced and lethargic. He had cool extremities, with a capillary return of 4 seconds, a heart rate of 150 beats per minute, a respiratory rate of 68 breaths per minute, and a skin temperature of 36.6°C. There was no sign of respiratory difficulty. The patient's anterior fontanelle was not distended, and his posture was normal. His abdomen was soft, without organomegaly. Movements were normal in all limbs, with normal tone and reflexes. The patient's anus was in a normal position, and he passed stools without difficulty. His back was normal, with no sign of sinuses or fistulas. Blood and urine cultures were obtained. Blood tests showed a C-reactive protein level of 25 g/mL (normal: Ͻ10 g/mL) and a white blood cell count of 10 300 cells per mm 3 (neutrophils: 8000 cells per mm 3 ). Results of a chest radiograph were normal. Lumbar punctures were performed as part of the septic screening and on 2 occasions revealed frank yellow-green pus, which showed large numbers of pus cells and mixed flora with Gram-staining and subsequently showed heavy growth of Escherichia coli and enterococci. A provisional diagnosis of mixed-organism meningitis was made, and the infant began broad-spectrum antibiotic treatment and was transferred to the neonatal intensive care unit of Wellington Hospital for additional in...

Pediatric Spinal Epidural Abscess: A 9-Year Institutional Review and Review of the Literature

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A 3-Month-Old Infant with Upper Extremity Weakness

“…Epidural abscesses are very rare in the pediatric population. Most occur in the mid-thoracic or lower lumbar region; 2 and there are previous reports of cases in the presacral, 3 lumbar, and intradural extramedullary thoracic areas. 4 It appears that an epidural abscess complicating a congenital neurenteric fistula at the level of the cervical spinal cord has not been previously reported.…”

Fetal extraperitoneal rectal perforation presenting after duodenal atresia repair

“…In the absence of neurologic features and signs of definite spinal involvement on magnetic resonance imaging, we would anticipate that a defunctioning colostomy will be sufficient to achieve diversion to prevent further complication, followed by a formal posterior sagittal exploration on a later date. If the patient is unwell at presentation and neurosepsis is suspected (eg, in neuroenteric fistula), one has to be prepared to also perform a laminectomy and debridement [9]. If peritonitis is the cause of systemic sepsis, peritoneal washout during laparotomy and colostomy formation can be performed.…”