%0 Journal Article
%T Perirectal Abscess Masquerading as Cauda Equina Syndrome in an Otherwise Healthy 12-Year-Old Child
%A Dylan Dean
%J Case Reports in Emergency Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/817124
%X A 12-year-old boy was brought to an urgent care center for fever, back pain, and abnormal gait. In addition to back pain, the patient was found to be persistently febrile but also had decreased perianal sensation and bowel incontinence. He was therefore referred to the emergency department where his back pain improved without medication but he was still febrile with bowel incontinence and persistently decreased perianal sensation. An MRI was ordered to evaluate possible cauda equina syndrome and revealed a perirectal abscess. The child ultimately underwent an exam under anesthesia with pediatric surgery and had a drain placed. This case highlights a unique presentation of perirectal abscess masquerading as cauda equina syndrome. A discussion of important considerations in emergency room diagnosis and management is presented. 1. Introduction Cauda equina syndrome due to epidural abscess should be high in the differential diagnosis of patients presenting with fever, back pain, decreased perianal sensation, and bowel incontinence but other disease processes can masquerade as this spinal cord pathology. Presented is to our knowledge the only case of a perirectal abscess in a preadolescent child presenting with exam findings suggestive of cauda equina syndrome. 2. Case Presentation A 12-year-old otherwise healthy boy was referred from an urgent care center to our emergency department for fever and back pain. Per telephone report from the referring facility, the child had had a few days of leg pain and lumbar spine pain and was febrile to 102¡ãF. A rectal exam was performed during which the child was reportedly incontinent of ¡°bloody-brown stool.¡± The patient arrived by ambulance to our emergency department in no acute distress. He complained of bilateral lower leg pain over the past week that had started laterally in his left hip, was achy, radiated to his lower legs but not to his feet, and was worse with movement and better somewhat with rest. His mom reported that he had abnormal gait. By the day of evaluation, he had developed focal lower back pain that was achy, sometimes sharp, worse with movement and sitting but better when supine. He had also been febrile to 101¡ãF at home prompting his mother to bring him to urgent care. He had had no urinary retention associated with his back pain although he did have the above reported bowel incontinence. The patient stated that he could not feel the rectal exam at the urgent care center nor sense that he had been incontinent of stool until he was told that he had been so. Of note, he emphasized that his leg pain
%U http://www.hindawi.com/journals/criem/2014/817124/