A vaginal CSF leak.

A 26-year-old woman presented to her gynecologist with persistent clear vaginal fluid loss for 2 months, accompanied by symptoms of headache and vertigo. Subsequently, she developed tenesmus. Surgical exploration revealed a duplicated anus and a presacral mass draining clear fluid containing white particles. In the following hours the patient developed a fulminant meningitis. Imaging (figure) revealed a neuroenteric fistula communicating with the thecal sac through a ventral sacral meningocele. This combination of anorectal malformation, sacral defect, and meningocele is known as the Currarino triad.1,2 Early recognition of this entity is of paramount importance in preventing a potentially devastating meningitis.