PRESACRAL PHLEGMON AND MENINGITIS AS COMP LICATIONS DUE TO A FOREIGN-BODY IN THE RECTOSIGMOID

A 24-year-old patient presented with severe back pain in the lumbar an d sacral regions and septic temperatures up to 40-degrees-C. Lasegue's sign was bilaterally positive. An enhanced cell count was seen in the CSF (1877 cells/mul, erythrocytes 1024/mul). Total protein concentrat ion was 4440 mg/dl. The patient also suffered from granulocytic pleocy tosis. X-ray as well as scintigrams revealed inflammation of the presa cral soft parts involving the os sacrum and bone marrow. Treatment wit h doxycyclin (200 mg/d), fosfomycin (5 g/d), netilmicin (400 mg/d) and ofloxacin (200 mg/d) succeeded in curing the meningitis, whereas the presacral phlegmon persisted. Endoscopic examination showed a rod-shap ed foreign body in the rectum that had penetrated deeply into the muco sa and required deformation and removal by laser. The plastic rod of 1 0 cm length was probably a liquorice stick. The patient denied introdu cing it per anum; he suspected having swallowed it while drunk. The in flammation subsided rapidly after removal of the foreign body.