{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T23:42:54Z","timestamp":1768434174568,"version":"3.49.0"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2013,1,1]],"date-time":"2013-01-01T00:00:00Z","timestamp":1356998400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2013,7,16]],"date-time":"2013-07-16T00:00:00Z","timestamp":1373932800000},"content-version":"vor","delay-in-days":196,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>INTRODUCTION:<\/jats:title>\n                    <jats:p>Ischiorectal abscesses have been shown to form sinuses with various deep structures but continuity with the spinal canal is extremely rare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PRESENTATION OF CASE:<\/jats:title>\n                    <jats:p>A previously healthy sixty-five year old man presented emergently with rectal pain, weight loss and recurrent severe tension headaches. He had systemic sepsis and resultant coagulapathy (INR 3.4) which precluded investigation of neurological symptoms by lumbar puncture. MRI rectum demonstrated a well circumscribed fluid collection with direct connection to the spinal canal and containing meningeal tissue. It extended inferiorly to the right ischiorectal fossa and abutted the natal cleft. A radiological diagnosis of ischiorectal abscess which had become continuous with a previously existing anterior sacral myelomeningocoele (ASM) was made. He was treated with broad spectrum antibiotics and a neurosurgical opinion was sought. He remained clinically unwell (septic and coagulopathic) until the abscess fistulated through the perianal skin, draining pus mixed with clear fluid (likely CSF) at which point he improved systemically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION:<\/jats:title>\n                    <jats:p>Few general surgeons would be faced with acute management of complicated ASM. Paucity of literature made application of evidence based medicine difficult. In fit healthy patients surgery is the mainstay of treatment as myelomengingoceles do not regress spontaneously. Conservative management is associated with up to 30% mortality (largely due to bacterial meningitis). The patient in this case was adamant that he did not consent to definitive surgical intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>This case highlights challenges encountered in the management of complicated ASM in a general hospital.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2012.08.005","type":"journal-article","created":{"date-parts":[[2012,9,1]],"date-time":"2012-09-01T11:33:50Z","timestamp":1346499230000},"page":"299-301","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Beware the ischiorectal abscess"],"prefix":"10.1097","volume":"4","author":[{"given":"A.M.","family":"Hogan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Mannion","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.S.","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W.","family":"Khan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Waldron","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Barry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-19-20260114","first-page":"808","article-title":"Anterior sacral meningocele. case report","volume":"156","author":"Andersen","year":"1990","journal-title":"Acta Chirurgica Scandinavica"},{"key":"R2-19-20260114","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1227\/00006123-199012000-00020","article-title":"bilateral anterior sacral and intrasacral meningeal and perineurial cysts: case report and review of the literature","volume":"27","author":"North","year":"1990","journal-title":"Neurosurgery"},{"key":"R4-19-20260114","doi-asserted-by":"crossref","first-page":"366","DOI":"10.3171\/jns.1988.68.3.0366","article-title":"Updated assessment and current classification of spinal meningeal cysts","volume":"68","author":"Nabors","year":"1988","journal-title":"Journal of Neurosurgery"},{"key":"R5-19-20260114","first-page":"441","article-title":"Anterior sacral meningocele in pregnancy","volume":"69","author":"Kofinas","year":"1987","journal-title":"Obstetrics & Gynecology"},{"key":"R6-19-20260114","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1007\/s10350-004-0664-2","article-title":"Anterior sacral meningocele with presacral cysts","volume":"47","author":"Krivokapic","year":"2004","journal-title":"Diseases of the Colon and Rectum"},{"key":"R7-19-20260114","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1053\/jpsu.2001.28860","article-title":"Familial presacral masses: screening pitfalls","volume":"36","author":"Singh","year":"2001","journal-title":"Journal of Pediatric Surgery"},{"key":"R8-19-20260114","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1007\/BF02560112","article-title":"Anterior sacral meningocele and the scimitar sign. Report of a case","volume":"31","author":"Kovalcik","year":"1988","journal-title":"Diseases of the Colon and Rectum"},{"key":"R9-19-20260114","first-page":"986","article-title":"Anterior sacral meningocele","volume":"126","author":"Amacher","year":"1968","journal-title":"Surgery, Gynecology and Obstetrics"},{"key":"R10-19-20260114","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1227\/00006123-198007000-00010","article-title":"Anterior sacral meningocele: two case reports and discussion of surgical approach","volume":"7","author":"Smith","year":"1980","journal-title":"Neurosurgery"},{"key":"R11-19-20260114","doi-asserted-by":"crossref","first-page":"204","DOI":"10.2176\/nmc.43.204","article-title":"Surgical strategy for anterior sacral meningocele","volume":"43","author":"Tani","year":"2003","journal-title":"Neurologia Medico-Chirurgica"},{"key":"R12-19-20260114","first-page":"42","article-title":"Repair of myelomeningocoele: how I do it","volume":"1","author":"Shehu","year":"2009","journal-title":"Journal of Surgical Technique and Case Report"},{"key":"R13-19-20260114","first-page":"368","article-title":"Myelomeningocoele: long term neurosurgical treatment and follow up in 202 patients","volume":"107","author":"Talamonti","year":"2007","journal-title":"Journal of Neurosurgery"},{"key":"R14-19-20260114","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1007\/s11604-011-0582-x","article-title":"Unusual presentation of an anterior sacral meningocele: magnetic resonance imaging, multidetector computed tomography, and fistulography findings of bacterial meningitis secondary to a rectothecal fistula","volume":"29","author":"Koksal","year":"2011","journal-title":"Japanese Journal of Radiology"},{"key":"R15-19-20260114","first-page":"487","article-title":"Rectothecal fistula secondary to an anterior sacral meningocele","volume":"8","author":"S\u00e1nchez","year":"2008","journal-title":"Journal of Neurosurgery: Spine"}],"container-title":["International Journal of Surgery Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261212001460?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261212001460?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01612930-201304030-00019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T13:20:21Z","timestamp":1768396821000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01612930-201304030-00019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,1]]},"references-count":14,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2013]]}},"URL":"https:\/\/doi.org\/10.1016\/j.ijscr.2012.08.005","relation":{},"ISSN":["2210-2612"],"issn-type":[{"value":"2210-2612","type":"print"}],"subject":[],"published":{"date-parts":[[2013,1]]}}}