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Anterior sacral meningoceles are rare forms of spinal dysraphism produced by herniation of the thecal sac through a bone defect in the anterior sacral wall. The patients may remain asymptomatic or present with nonspecific symptoms such as long-term constipation, urinary dysfunction, lower back pain, or perineal hypoalgesia These lesions are difficult to diagnose without a strong suspicion due to the multiple range of nonspecific symptoms such as low lumbar pain, obstetric problems, and bowel and bladder difficulties. Special care should be taken in order to avoid erroneous diagnoses that may expose the patient to unnecessary surgical procedures. Because these lesions usually do not regress spontaneously, surgical treatment is mandatory for symptomatic or growing masses. The dural defect can be repaired with a variety of anterior transabdominal or posterior transsacral approaches. We present the case of a 82-year-old female patient with a giant anterior sacral meningocele that was initially confused with various  entities such as inguinal hernia and an ovarian cyst. Once the anterior sacral meningocele was conffirmed through a MRI-scan she was successfully treated using a posterior transsacral approach. We present a brief review of the current literature and discuss the surgical treatment options. ***Keywords:*** _Anterior sacral meningocele, posterior approach, neurosurgery._ abdominal pain._