Case report
Feculent meningitis: polymicrobial meningitis in colorectal surgery

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Abstract

Polymicrobial anaerobic meningitis is a rare event secondary to a contiguous infection in the head or neck. Anaerobic meningitis due to a meningo-intestinal fistula is a rare event with only two cases reported in the literature. We describe a new case of adult polymicrobial anaerobic meningitis after colorectal surgery and radiotherapy and review the previous two cases.

Introduction

Polymicrobial anaerobic meningitis is a rare event secondary to a contiguous infection mainly in the head or neck, such as otitis media, suppurative pharyngitis, sinusitis or mastoiditis, and also after abdominal trauma or neurosurgical procedures Brown et al 1994, Goldman et al 1998, Ibrahim 1998. However, the frequency of this infection is underestimated because clinical laboratories do not routinely culture cerebrospinal fluid for anaerobes (Ray, Smith, Wasilauskas & Zabransky, 1993). Moreover, as appropriate antibiotic therapy is crucial to reduce the morbidity and mortality of this disease, suspicion of anaerobes is highly recommended.

We describe a new case of adult polymicrobial anaerobic meningitis after colorectal surgery and radiotherapy and review the two cases reported in the literature Walsh et al 1982, Chun et al 1995.

Section snippets

Case report

A 68-year-old diabetic male was brought to the hospital almost unconscious and with sudden onset of fever (38°C), chills, sweats, vomiting and right lumbar pain.

Four months before admission, he had undergone left colectomy with proximal colostomy and intraoperative radiotherapy because of rectal cancer. He suffered from many post-operative complications such as intestinal obstruction, evisceration, surgical wound infection and a perineal abscess which required posterior surgical intervention.

Discussion

Anaerobic meningitis due to a fistula between the gastrointestinal tract and the meninges is a rare event; only two cases have been reported in the literature (MEDLINE 1960–2000).

In both cases, the patients had undergone surgery and radiation therapy for rectal cancer. They also presented with severe meningitis with fever and different grades of mental disturbance. The cerebrospinal cultures yielded fecal flora. CT and MRI images or myelography revealed a fistula between the epidural space and

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