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Juan Patino renamed case report.md to case report 1.md
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# Case Report
A 82-year-old woman with a history of lumbar and low abdominal pain was referred with a diagnosis of inguinal hernia on the left side to the general surgeon, the patient underwent surgery and the inguinal hernia was repaired, however there was no improvement over a period of six months.
Following her insistent complains, the physician requested both an abdominal ultrasound scan, which showed a large cystic collection on the pelvic area consistent with a giant ovarian cyst, and lumbar X-rays which confirmed the presence of a severe scoliotic deformity between L2 and S1, with a right sided curvature and over 45 degrees measured with the cobb angle. The patient was then referred to the gynecologist who performed an endoscopic approach with puncture of the cyst, the content was similar in characteristics to the CSF raising the suspicion of an anterior sacral meningocele, hence the procedure was stopped immediately and the patient was kept admitted into the hospital for 7 more days where consecutive imaging examinations ruled out and abdominal collection of CSF.
The patient was then referred to our practice, she mainly complain of lower abdominal pain with overflow incontinence, sciatic pain in both legs with a predominance on the left side, and mechanical lower lumbar pain. The neurological examination showed no motor deficits in the lower extremities with preservation of tone and reflexes, sensitivity was patchy in both legs around L5 and S1 dermatomes, but resulted quite inconsistent. An MRI (Figure 1.) showed an anterior pre-sacral cyst eroding the anterior wall of S2 and S3. The collection measured around 5x5cm, compressed the rectum and the bladder in a significant way.
