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

Abstract

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.

An Asymptomatic Large Anterior Sacral Meningocele in a Patient with a History of Gestation: A Case Report with Radiological Findings

“…They are generally diagnosed in the second or third decades and are more prevalent in women. They may be asymptomatic or present as nonspecific symptoms such as long-term constipation, urinary dysfunction, dysmenorrhea, lower back pain, or perineal hypoalgesia [1, 4, 5]. These symptoms may be due to direct compression of the herniated meningeal sac, spinal cord tethering, or sacral nerve root compression.…”

“…In addition, congenital defects that may occur in autonomic innervation of the bladder and anal sphincter may be associated with constipation and urinary dysfunction. Symptoms such as dysmenorrhea and dyspareunia may cause direct compression as well as lead to venous congestion as a result of the compression on the pelvic veins [4, 5]. In addition, headache can be seen in 10 to 15 percent of patients.…”

“…Although it may be asymptomatic, some authors have reported infectious complications such as meningitis. Therefore, surgical treatment is recommended [5, 9]. Some physicians have recommended surgical treatment if there is an increase in lesion size or if the sacral meningocele is symptomatic [2].…”

“…While anterior sacral meningocele usually occurs as a congenital defect, most acquired sacral meningoceles occur due to dural ectasia associated with neurofibromatosis, Marfan's syndrome, and Ehlers-Danlos syndrome [4]. Most of the symptoms are due to compression on the adjacent organs, and the most common symptom is constipation [5]. …”

Spontaneous reduction of native kidney size involving angiomyolipoma lesions in a kidney transplant recipient with tuberous sclerosis complex

“…ASM is a rare form of sacral agenesis, and approximately 250 cases have been reported. 1 Its etiology is speculated to be a congenital neural tube defect causing sacral malformation. ASM is divided into two groups based on the presence or absence of TSC.…”