Anaerobic Meningitis Secondary to a Rectothecal Fistula Arising from an Anterior Sacral Meningocele: Report of a Case and Review of the Literature

Abstract

An anterior sacral meningocele is a diverticulum of the thecal sac protruding anteriorly from the sacral spinal canal into the extraperitoneal presacral space. It is a rare congenital anomaly comprising of a thin wall of fibrous connective tissue, and containing cerebrospinal fluid and, occasionally, adjacent nerve fibers. We report an unusual case of a 48-year-old male who presented with meningitis secondary to a rectothecal fistula arising from an anterior sacral meningocele.

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

“…4 One of the presentations for women of childbearing age is a pelvic mass on prenatal examination or dystocia at labor. 1 Bacterial meningitis is rare. [1][2][3] Pneumocephalus is defi ned as the pathological presence of intracranial air that can be localized in subdural, subarachnoid, epidural, intraventricular, and intraparenchymal spaces.…”

“…1 Bacterial meningitis is rare. [1][2][3] Pneumocephalus is defi ned as the pathological presence of intracranial air that can be localized in subdural, subarachnoid, epidural, intraventricular, and intraparenchymal spaces. Although central nervous system infection due to gas-forming microorganisms or CSF fi stulas can (rarely) cause pneumocephalus, the most common cause is trauma followed by intracranial neoplasm, previous surgery, or neurosurgical intervention.…”

“…Although about 250 patients with ASM have been reported in the literature since 1837, ASM with a rectothecal fi stula presenting with meningitis has been rare in the English-language literature. [1][2][3] We report an unusual case of a previously healthy woman who presented with meningitis, including pneumocephalus, secondary to a rectothecal fi stula arising from an ASM with multidetector-row computed tomography (MDCT), magnetic resonance imaging (MRI), and fi stulography fi ndings.…”

“…1 The clinical presentation of ASM is typically due to local pressure on adjacent pelvic organs. Although about 250 patients with ASM have been reported in the literature since 1837, ASM with a rectothecal fi stula presenting with meningitis has been rare in the English-language literature.…”

Diverticulitis complicated by fistulous communication of sigmoid colon with anterior sacral meningocele in a patient with Marfan syndrome

“…Anterior sacral meningoceles have been reported to enlarge with age, and complications can be related to mass effect, including constipation, urinary retention, and prolonged labor in women. A sacral meningocele can also predispose the patient to recurrent episodes of meningitis ( 10 ).…”