Rectothecal fistula complicating anterior sacral meningocele repair

Area of Science:

• Neurosurgery
• Gastroenterology
• Radiology

Background:

• Congenital anterior sacral meningoceles require surgical repair.
• Intraoperative rectal perforation can lead to complications.
• Postoperative meningitis symptoms may indicate cerebrospinal fluid leaks or fistulas.

Observation:

• A 34-year-old male developed a rectothecal fistula post-sacral meningocele repair.
• Symptoms included signs of meningitis and a cerebrospinal fluid leak.
• Imaging revealed a pseudomeningocele and an abdominal fluid collection.

Findings:

• Computed tomography (CT) and magnetic resonance imaging (MRI) showed a pseudomeningocele and fistulization.
• CT myelography confirmed a direct fistulous connection between the pseudomeningocele and the rectum.
• This iatrogenic rectothecal fistula presented as a rare postoperative complication.

Implications:

• Elevated clinical suspicion for rectothecal communication is crucial in patients with sacral meningocele repair and postoperative meningitis symptoms.
• CT myelography is recommended for diagnosing viscero-thecal fistulas when initial evaluations are suggestive.
• Early diagnosis and management are essential to prevent severe complications.