DOI: 10.14260/jemds/2014/3735

CASE REPORT

AN UNUSUAL CASE OF HUGE SACCROCOCCYGEAL MENINGOCELE

Shireen A1,Lalitha Shivanna2

HOW TO CITE THIS ARTICLE:

Shireen A, LalithaShivanna“An Unusual Case of Huge SaccrococcygealMeningocele”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 57, October30; Page: 13054-13056,

DOI: 10.14260/jemds/2014/3735

ABSTRACT:Meningoceleistheleastcommonformofspinabifida.It is most commonamongfemalefetus.1Meningocelehasabetterprognosisthanmeningomyelocelesinceitdoesnotcontainneuralelement.2

INTRODUCTION:Spinabifidameningoceleandmyelomeningoceleareamongthemostcommonbirthdefects,withworldwideincidenceofabout1:10002births.Themeningocelealsocalledmeningealcystistheleastcommonformofspinabifida.Inthisformvertebradevelopsnormally,butthemeningesareforcedintothegapsbetweenthevertebrae.Asthenervoussystemremain undamaged, individualsunlikelytosufferlongtermhealthproblems.CausesofmeningoceleincludeteratomaandothertumorsofthesacrococcyxandofthepresacralspaceandCurrarinosyndrome.Themostcommonlocationofthemalformationsisthelumbarandsacralareas.Themotherswhohadpriorspinabifidacanbedecreasedbyupto70%3byfolicacidsupplementations.

CASEREPORT:A22yrsoldlady, G2P1L1with38wks+5daysgestationcameinactivelabor.Thescandoneat7mnthsofamennorheashowedasingleliveintrauterinegestationof27-28wksincephalicpresentationwithgoodcardiacactivityandadequateliquorwithestimatedfetalweight1.5kgcorrespondingtogestationalagewithsacrococcygealmeningocele.Thefetalcalvaria,spine,skinoverspine,face,heart,stomach,bothkidneys,bladderappearednormal.

AFIwas15cm.Therewasahugemassarisingfromthesaccrococcygealregionwithfewloculationsmeasuring9.2x6.5cmsuggestiveofsacrococcygealmeningocele.Therewerenootherassociatedanomalies.Thisistheultrasoundpictureshowingthecysticswellingarisingfromlowerendthespine.Herobstetrichistorysuggested,shewasmarriedfor3yrsit’sanon-consanguineousmarriage.Inpreviouspregnancypatienthaddeliveredanalivehealthyfemalebabyof2.75kgattermvaginally.

InthispregnancypatienthadregularANCinaPHC.Thereisnoh/otakingfolicacidinthefirsttrimester.Whenpatienthadcometousat8monthsofamenorrheawiththeabovescanreportshewassuggestedaconfirmationscanathighercentertoarriveataproperdiagnosisbutfailedtogetitdoneduetofinancialconstraint.Shedirectlycametousatterminactivelabor. Itwasaspontaneousonsetlaborprogresseduneventfully.Inthesecondstageoflabortherewasdelayinthedeliveryofaftercomingbuttockswhichwasfollowedbythedeliveryofsacrococcygealmass.

Thebabybornwasafemalechildweighing4.04kgalongwiththemass.Themassaloneweighed1.04kg.Onexaminationtherewasahugethickpedunculatedmassarisingfromthesacrococcygealregion,measuring25x25cm,cysticinnature,translucencytestpositive,noimpulsetransmittedoncrying.TherewasadiscreteswellingatthelevelofL1–L2measuring3x5cm,firminconsistencyaboutwhichwasnotcommentedintheantenatalscan.Theoverlyingskinwasnormalwithnoevidenceoftuftofhair/dimplingofskin/birthmarksuggestiveofspinabifidaocculta.Babywasmovingallforelimbs.TheAPGARwas10/10atbirth.

BabywasshiftedtoNICUforfurtherevaluation.Diagnosisofsaccrococcygealmeningocelewasmadeandpostedforsurgeryafter1wkofbirth.

DISCUSSION:CausesofmeningoceleincludeteratomaandothertumorsofthesacrococcyxandothertumorsofthesacrococcyxandofthepresacralspaceandCurrarinosyndrome4.Themostcommonlocationofthemalformationsisthelumbarandsacralareas.Thedifferentialdiagnosisforsacrococcygealmassissacrococcygealteratoma,terminalmyelocystocele,meningomyelocele,meningocele,lipoma,hamartoma,lymphangioma,hemangioma,chordomaandependydoma4.

CONCLUSION:Eventhoughspinabifidameningoceleisamongmostcommonbirthdefect,thiscasepresentingwithgiantmeningoceleatrarestsiteofthespinesacrococcygealjunction.Unusuallythisfetushadcephalicpresentationattermanddeliveredvaginallywithminimalassistance.Ifthemothersaresupplementedwithfolicacid,recurrenceofspinabifidainsubsequentpregnancycanbedecreasedbyupto70%.

REFERENCES:

  1. YuJ.A,SohaeyR,KennedyA.M.andSeldenN.R.TerminalMyelocystoceleandSacrococcygealTeratoma,AJNRJune200728:1058-1060.
  2. FeltesCH,FountasKN,DimopoulosVG,etal.Cervicalmeningoceleinassociationwithspinalabnormalities.ChildsNervSyst20:357-361,2004.
  3. D.Shedid,E.P.Roger,andE.C.Benzel,Sacralmeningocele:diagnosisandtreatment,SeminarsinSpineSurgery,vol.18,no.3,pp.161-167,2006.
  4. MatiourH,WoolleyM,TrivediS,etal.Sacrococcygealtumors.JPediatrSurg.2004:824-6.

J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 57/Oct 30 2014 Page 1