Anterior sacral meningocele masquerading as an ovarian cyst: a rare clinical presentation associated with Marfan syndrome

BACKGROUND Marfan syndrome is rarely accompanied by anterior sacral meningocele (ASM) resulting from erosion of the sacrum by dural ectasia. ASM may induce symptoms due to severe mass effects. ASM may also mimic ovarian cysts, and the risk of cerebrospinal fluid (CSF) leakage is high if spontaneous rupture of the cyst occurs. In this study, the authors presented a rare case of ASM with iatrogenic CSF leakage in a 34-year-old woman with suspected Marfan syndrome. OBSERVATIONS The patient initially presented with a giant ASM that was first misdiagnosed as an ovarian cyst. Previously, it had been partially resected, which was followed by iatrogenic CSF leakage. Symptoms of intracranial hypotension, including postural headache and dizziness, developed within 1 month. Brain magnetic resonance imaging (MRI) showed pituitary enlargement, bilateral subdural effusion, and tonsillar herniation. Preoperative computed tomography myelography provided three-dimensional (3D) examination of the deformed sacrum and CSF leakage site. Transabdominal approaches led to primary repair, and repair of the meningocele was achieved by intraoperative fluorescein fluorescence and 3D printed model–guided polymethyl methacrylate bone cement reconstruction. No CSF leakage or recurrent ASM was found at the 1.5-year follow-up visit. LESSONS Intraoperative intrathecal fluorescence and 3D-printed models are useful for ASM repair. Preoperative MRI is helpful for differentiating ASM from other causes of a huge pelvic mass, including ovarian cyst.

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First Data of Clinical Presentation of Siblings with Diagnosed Marfan Syndrome: Many but Not All

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1571884 ◽

2016 ◽

Vol 64 (S 02) ◽

Author(s):

F. Seggewies ◽

F. Arndt ◽

R. Kozlik-Feldmann ◽

G. Müller ◽

J. Olfe ◽

...

Keyword(s):

Marfan Syndrome ◽

Clinical Presentation

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Rupture of Giant Anterior Sacral Meningocele in a Patient with Marfan Syndrome: Diagnosis and Management

World Neurosurgery ◽

10.1016/j.wneu.2018.07.249 ◽

2018 ◽

Vol 119 ◽

pp. 137-141

Author(s):

Alex M. Hollenberg ◽

Avionna L. Baldwin ◽

Addisu Mesfin ◽

Howard Silberstein

Keyword(s):

Marfan Syndrome ◽

Diagnosis And Management ◽

Syndrome Diagnosis ◽

Anterior Sacral Meningocele

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A 40-Year-Old Woman With Cauda Equina Syndrome Caused by Rectothecal Fistula Arising From an Anterior Sacral Meningocele

Neurosurgery ◽

10.1227/neu.0b013e3181f352ba ◽

2010 ◽

Vol 67 (5) ◽

pp. E1464-E1475 ◽

Cited By ~ 7

Author(s):

Eric Bergeron ◽

Alain Roux ◽

Jacques Demers ◽

Laurent E Vanier ◽

Lynne Moore

Keyword(s):

Cauda Equina Syndrome ◽

Unusual Case ◽

Clinical Presentation ◽

Cauda Equina ◽

Rectal Stump ◽

Sigmoid Resection ◽

Abdominal Approach ◽

Satisfactory Outcome ◽

Proximal Colostomy ◽

Anterior Sacral Meningocele

Abstract BACKGROUND AND IMPORTANCE: We present a rare case of a rectothecal fistula arising from an anterior sacral meningocele in a patient with Currarino syndrome. CLINICAL PRESENTATION: The patient was a 40-year-old woman presenting with cauda equina syndrome and ascending meningitis. The meningocele was removed using an anterior abdominal approach. A sigmoid resection was performed with rectal on-table antegrade lavage followed by closure of the rectal fistula, closure of the rectal stump, and proximal colostomy. Closure of the sacral deficit was carried out by suturing a strip of well-vascularized omentum and fibrin glue. CONCLUSION: We discuss the characteristics, management, and evolution of this unusual case. Prompt surgical management using an anterior approach, resection of the sac, closure of the sacral deficit, and fecal diversion resulted in a satisfactory outcome.

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Anterior sacral meningocele mimicking ovarian cyst: a case report

Medical Ultrasonography ◽

10.11152/mu.2013.2066.151.avp1asm2 ◽

2013 ◽

Vol 15 (1) ◽

pp. 67-70 ◽

Cited By ~ 13

Author(s):

Ahmet Veysel Polat

Keyword(s):

Case Report ◽

Ovarian Cyst ◽

Anterior Sacral Meningocele

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Anterior Sacral Meningocele Wrongly Diagnosed as Ovarian Cyst

Pediatric Neurosurgery ◽

10.1159/000321923 ◽

2010 ◽

Vol 46 (3) ◽

pp. 245-246 ◽

Cited By ~ 2

Author(s):

K.Y. Vamsi ◽

P. Sarat Chandra ◽

B.S. Sharma ◽

A.K. Mohapatra

Keyword(s):

Ovarian Cyst ◽

Anterior Sacral Meningocele

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Anterior sacral meningocele misdiagnosed for an ovarian cyst

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2007.04.006 ◽

2008 ◽

Vol 138 (2) ◽

pp. 249-250 ◽

Cited By ~ 3

Author(s):

Vladimír Beneš ◽

Pavel Barsa ◽

Richard Plný ◽

Petr Suchomel

Keyword(s):

Ovarian Cyst ◽

Anterior Sacral Meningocele

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Early Onset Marfan Syndrome: Atypical Clinical Presentation of Two Cases

Balkan Journal of Medical Genetics ◽

10.1515/bjmg-2015-0008 ◽

2015 ◽

Vol 18 (1) ◽

pp. 71-76 ◽

Cited By ~ 2

Author(s):

Abdullah Ozyurt ◽

A. Baykan ◽

M. Argun ◽

O. Pamukcu ◽

H. Halis ◽

...

Keyword(s):

Marfan Syndrome ◽

Early Onset ◽

Poor Prognosis ◽

Clinical Presentation ◽

Severe Form ◽

Early Age ◽

Newborn Period ◽

Heart Failure Treatment ◽

Failure Treatment ◽

Atypical Clinical Presentation

Abstract Early onset Marfan Syndrome (eoMFS) is a rare, severe form of Marfan Syndrome (MFS). The disease has a poor prognosis and most patients present with resistance to heart failure treatment during the newborn period. This report presents two cases of eoMFS with similar clinical features diagnosed in the newborn period and who died at an early age due to the complications related to the involvement of the cardiovascular system.

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Anterior sacral meningocele associated with a rectal fistula

Journal of Neurosurgery Spine ◽

10.3171/spi.1999.91.1.0124 ◽

1999 ◽

Vol 91 (1) ◽

pp. 124-127 ◽

Cited By ~ 5

Author(s):

Michael Owen Fitzpatrick ◽

William A. S. Taylor

Keyword(s):

Bacterial Meningitis ◽

Clinical Presentation ◽

Diagnosis And Treatment ◽

Rectal Fistula ◽

Content Type ◽

First Case ◽

Anterior Sacral Meningocele ◽

Fine Print

✓ The authors report a case of anterior sacral meningocele associated with a rectal fistula in a patient who had presented 20 years earlier with bacterial meningitis. To their knowledge, this is the first case in which a rectal fistula developed due to an anterior sacral meningocele. The clinical presentation, diagnosis, and treatment of this uncommon lesion is discussed.

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Management of Complex Ovarian Cysts in Newborns – Our Experience

Journal of Neonatal Surgery ◽

10.21699/jns.v6i1.448 ◽

2016 ◽

Vol 6 (1) ◽

pp. 3

Author(s):

Manjiri S ◽

Padmalatha SK ◽

Shetty J

Keyword(s):

Ovarian Cyst ◽

Spontaneous Regression ◽

Clinical Presentation ◽

Ovarian Tissue ◽

Serous Cystadenoma ◽

Ovarian Cysts ◽

Radiological Findings ◽

Operative Recovery ◽

Serous Cyst

Aims: To analyse the clinical presentation, clinicopathological correlation and management of complex ovarian cysts in newborn and infants.Materials and Methods: Over a period of 6 years (2009-2015), 25 newborns who were diagnosed to have ovarian cyst on antenatal ultrasound, were followed up. We collected data in the form of clinical features, radiological findings, pathology and mode of treatment.Results: Of the 25 fetuses who were diagnosed to have ovarian cysts, fourteen (56%) underwent spontaneous regression by 6-8 months. Eight were operated in newborn period while 3 were operated in early infancy. Seven had ovarian cyst on right side, 4 had on left side. Eight babies underwent laparoscopy while 3 underwent laparotomy. Histopathology showed varied features of hemorrhagic cyst with necrosis and calcification, serous cystadenoma with hemorrhage, benign serous cyst with hemorrhage and simple serous cyst. Post-operative recovery was uneventful in all.Conclusion: All the ovarian cysts detected antenatally in female fetuses need close follow-up after birth. Since spontaneous regression is known, only complex or larger cysts need surgical intervention, preferably by laparoscopy. Majority of the complex cysts show atrophic ovarian tissue hence end up in oophorectomy but simple cysts can be removed preserving normal ovarian tissue whenever possible.

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