Post meningocele repair urinary ascites in a neonate--a rare presentation

Abstract

A full-term female neonate with a large lumbosacral meningocele developed sudden abdominal distension and urinary retention after meningocele repair. An erect abdominal radiograph showed homogeneously opacified areas with a paucity of intestinal gas. Abdominal ultrasound revealed ascites with multiple internal echoes. With a provisional diagnosis of hollow viscus perforation, an emergency laparotomy was performed, which failed to reveal any leak from the urinary tract. However, fluid analysis confirmed the diagnosis of urinary ascites. The patient developed repeated episodes of urinary retention after catheter removal. She was started on clean intermittent catheterization (CIC) to ensure adequate bladder drainage. At 6 months of follow-up, ultrasound of the urinary tract, voiding cystourethrogram, and magnetic resonance imaging of the spine were all within normal limits. The CIC was discontinued, and the patient was observed. At present, she is voiding normally with a good stream. Failure to establish normal micturition after meningocele repair and CIC requirements suggested a neurogenic cause. Bladder rupture, secondary to spinal shock resulting in bladder atonia, could not be ruled out. The perforation (leading to urinary ascites) could be owing to bladder atonia and spinal shock rather than detrusor sphincter dyssynergia.