|Year : 2020 | Volume
| Issue : 1 | Page : 94-95
Sacral meningocele presenting as gluteal mass: A report of two cases
Vinit Kumar Thakur1, Rakesh Kumar2, Ramdhani Yadav3, Vijayendra Kumar4, Rupesh Keshri2, Zaheer Hasan1, Ramjee Prasad5, Digamber Chaubey5, Sandip Kumar Rahul5
1 Additional Professor, IGIMS, India
2 Senior Resident, IGIMS, India
3 Associate Professor, IGIMS, India
4 Professor & Head, IGIMS, India
5 Assistant Professor, Dept. of Paediatric Surgery, IGIMS, India
|Date of Submission||09-Dec-2019|
|Date of Acceptance||21-Feb-2020|
|Date of Web Publication||16-Nov-2020|
Vinit Kumar Thakur
Additional Professor Dept. of Paediatric Surgery, IGIMS, Patna
Source of Support: None, Conflict of Interest: None
Meningocele is a common neural tube defect. Mostly seen in lumbosacral region in midline; when encountered at atypical site in form of anterior or lateral position in relation to spine may cause confusion .Cystic gluteal swelling was found to be occult sacral meningocele in this case.
Keywords: gluteal; meningocele; occult; sacral.
|How to cite this article:|
Thakur VK, Kumar R, Yadav R, Kumar V, Keshri R, Hasan Z, Prasad R, Chaubey D, Rahul SK. Sacral meningocele presenting as gluteal mass: A report of two cases. J Indira Gandhi Inst Med Sci 2020;6:94-5
|How to cite this URL:|
Thakur VK, Kumar R, Yadav R, Kumar V, Keshri R, Hasan Z, Prasad R, Chaubey D, Rahul SK. Sacral meningocele presenting as gluteal mass: A report of two cases. J Indira Gandhi Inst Med Sci [serial online] 2020 [cited 2021 Feb 26];6:94-5. Available from: http://www.jigims.co.in/text.asp?2020/6/1/94/300752
| Introduction|| |
Meningocele is one of the commonest neural tube defects in infancy. It is mostly obvious on physical examination of the baby. Occult meningocele often eludes us if not suspected in advance. We present a case, where meningocele was masquerading as gluteal swelling in a 2- year-old baby.
| Case Report|| |
Two year-old-male baby presented with a gluteal swelling, progressively increasing in size for past one month. Baby was asymptomatic before this, parents did not have any complains. Recent appearance of a swelling on the right buttock of baby compelled them to consult a primary health care. [Figure 1]
There was no history of trauma or intramuscular injection. Baby was active with no complains of fever or pain.
In a tertiary care centre, after preliminary sonogram of gluteal swelling, he had magnetic resonance imaging of the lumbo- sacral region.
This baby presented to our hospital for surgical management of gluteal swelling. The child weight was 12kg and other anthropometric parameter including head circumference were appropriate for age. There was no neurological deficit. Haematological investigation and kidney function test were normal. Ultrasonography scan of swelling demonstrated cystic lesion without internal echoes, swelling was partially reducible. A reducible swelling in close vicinity of spinal canal made them to advise magnetic resonance imaging of swelling. This baby had two sacral meningocele. Magnetic resonance imaging of swelling revealed that from L4-L5 intervertebral disc level to S4 level there was a posterior epidural collection showing fluid signal intensity on both T1and T2 weighted images. This collection measured about 6cm in length. At the right lamina of S1 vertebra, there was small outpouching connecting this extradural collection to extraspinal fluid which measured about 1cm in size. There was another irregular fluid collection communicating with sacral spinal canal S4-S5 level extending in the midline and in the right gluteus muscle. It measured about 1.6cm/7cm/5cm in size.[Figure 2]. After thorough workup, baby was kept on intravenous antibiotics and planned for surgery.
|Figure 2: MRI of sacral region revealing communication of the mass with the spinal canal|
Click here to view
On exploration, it was found to be sacral meningocele, extending laterally deep to medial and upper quadrant of gluteal muscle [Figure 3] .Cerebrospinal fluid was drained out and sent for culture to rule out infection. Duroplasty was done with non absorbable suture after confirming underlying cord. Muscle flap cover given as second layer for extra protection to prevent cerebrospinal fluid leak. Postoperative recovery was uneventful. There was no neurological deficit in immediate post operative period. The child is under follow up for any bladder or bowel problem and to detect hydrocephalus in future.
|Figure 3: Intraoperative picture showing communication of the atypical sacral with the spinal canal|
Click here to view
| Discussion|| |
A meningocele, is an outpouching of leptomeninges through a developmental defect in the dura, without presence of cord structures. This deformity mostly occurs at the stage of neurulation that prevents the neural groove from closing. The arch of vertebra at one or more levels are involved with protruded meningeal sac covered with only layer of skin. Meningomyeloceles are the most common form of neural tube defect and remain mostly visible. Atypical presentations in form of anterior, lateral and occult lesions that are not visible externally are not frequent. Baby or even grown up children with any protuberance, pigmented patch or tuft of hair in dorsal midline with or without vertebral deformity must be subjected to further investigation to rule out underlying neural tube defect.Unexpected increase in size of swelling may be because of trauma and infection; in this case parents were not sure about trauma. History of lower limb weakness, problems associated with voiding and defecation must be asked and confirmed while explaining the outcome and future management of these pati’ents.One must go for magnetic resonance imaging of spine of his or her patients, if a clinician is suspecting spina bifida occulta or aperta,. Drainage through needle aspiration or by incision that is a common practice in rural India for cystic swelling may complicate it by converting it into abscess or cerebrospinal fluid fistula formation,,.Surgical excision with preservation of neural placode followed by duroplasty is desired in these patients. Regular follow up is necessary for early detection of re-tethering of cord and hydrocephalus,.
| Conclusion|| |
Cystic swelling in close proximity of spine must be evaluated for meningomyelocele. Injudicious aspiration or drainage would be disastrous in these cases.
Conflict of Interest: None declared
Source of support: None declared
| References|| |
Shetty DS, Lakhkar BN. Lateral sacral lipomeningomyelocele:a rare anomaly. J.Neurol India 2002; 50:204.
G Raghavendra, Rashmi TM. Lateral Meningomyelocele in a Neonate: A Case Report. J Neonatal Surgery 2016; 5:1-4.
Seddighi A, Seddighi AS. Lateral sacral meningocele presenting as a gluteal mass:a case report.journal of medical case reports 2010; 4:81.
Kaur N, Mishra SC, Vijayragavan P, et. al. Lateral sacral meningomyelocoele as a gluteal swelling - an unusual presentatìon. J Indian Med Assoc. 2005; 10:554-6.
Kaur N, Mishra SC, Vijayaragvan P, Minocha VR. Lateral sacral meningomyelocele as a gluteal swelling--an unusual presentatìon. J Indian Med Assoc. 2005; 10:554-6 Kaur N, Mishra SC, Vijayaragvan P, Minocha VR. Lateral sacral meningomyelocele as a gluteal swelling--an unusual presentatìon. J Indian Med Assoc. 2005; 10:554-6
Singh DK, Kumar B, Bagaría HR. The human tail; rare lesion with occult spinal dysraphism- a case report. J.pediatr surg 2008; 43:413.
Mushtaq G, Hussain I, Khan J. Lateral meningocele with asymmetric canal stenosis:A case study.Saudi Journal of Biological Sciences 2015; 22:102-5.
[Figure 1], [Figure 2], [Figure 3]