Published online October 1, 2004
PEDIATRICS Vol. 114 No. 4 October 2004, pp. e527-e531 (doi:10.1542/peds.2003-0496-F)
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ELECTRONIC ARTICLE

Presacral Neuroenteric Fistula in a Newborn Presenting With an Epidural Abscess: Case Report and Review of the Literature

Balsam Darwish, FRACS*, Thorsten V. Stanley, FRCP{ddagger}, Agadha Wickremesekera, FRACS*, Brendon Bowkett, FRACS§ and Mark Leadbitter, FRACR||

* Departments of Neurosurgery
{ddagger} Paediatrics
§ Paediatric Surgery
|| Radiology, Wellington Hospital and Wellington School of Medicine and Health Sciences, Wellington, New Zealand

We describe a newborn infant (<24 hours of age) who presented with mild swelling on the back and buttocks attributable to a neuroenteric fistula complicated by an epidural parasacral abscess infected with mixed coliforms. Epidural abscesses in infancy are extremely rare, and one has not been observed previously in the newborn period. The infant was surprisingly mildly affected. Prompt intervention led to an excellent outcome. Coliforms may colonize the infant gut in <24 hours, even in the developed world. Unexplained swellings on the backs of infants should lead to a search for underlying malformations and an early surgical review, which is best conducted with a combined pediatric surgical and neurosurgical approach.

Key Words: newborn infant • neuroenteric fistula • epidural abscess • coliform • meningitis

Abbreviations: MRI, magnetic resonance imaging • SEA, spinal epidural abscess

Accepted May 12, 2004.