# Rare Case of Anterior Sacral Meningocele in a 30‐Year‐Old Male: Surgical Excision Using the Posterior Sagittal Approach

## TL;DR

A rare case of anterior sacral meningocele in a 30-year-old male was successfully treated with surgery, highlighting the importance of MRI and the posterior sagittal approach.

## Contribution

This case report presents a rare ASM diagnosis in a male adult and validates the posterior sagittal surgical approach for effective treatment.

## Key findings

- MRI confirmed the diagnosis of ASM and showed the classic Scimitar Sign on pelvic X-ray.
- Surgical excision via the posterior sagittal approach led to significant improvement in bowel and urinary symptoms.
- ASM should be considered in the differential diagnosis for adults with chronic constipation and urinary retention.

## Abstract

Anterior sacral meningocele (ASM) is an uncommon congenital spinal abnormality in which the meningeal sac herniates through an abnormality in the anterior sacrum into the presacral space. It is more observed in females and usually asymptomatic; large ASMs may cause pressure effects on nearby pelvic structures. A 30‐year‐old male presented with prolonged constipation and recurrent episodes of urinary retention, which developed to complete urinary obstruction. Ultrasound demonstrated a large presacral cystic mass, and MRI confirmed the diagnosis of an ASM. Pelvic x‐ray revealed the classic Scimitar Sign. Neurological examination showed no abnormalities. The patient was subjected to surgical excision through the posterior sagittal technique. Intraoperative steps consisted of laminectomy, durotomy, sac decompression, and fascial graft repairing. After the procedure, the patient experienced a smooth recovery with notable improvement in bowel and urinary symptoms. ASM is an uncommon etiology of pelvic mass and neurogenic bladder symptoms occurring in adults. This case underscores the diagnostic importance of MRI and pelvic X‐ray, and also supports the posterior sagittal approach as an effective, low‐complication surgical approach. ASM should be taken as a differential diagnosis for adult patients having symptoms of chronic constipation and urinary retention. Prompt imaging and surgical treatment can notably improve outcomes.

Anterior sacral meningocele is a rare cause of chronic constipation and urinary retention in adults. MRI is essential for diagnosis, with the scimitar sign as a helpful radiologic clue. The posterior sagittal approach provides safe and effective surgical management with excellent outcomes.