deletions | additions       diff --git a/discussion.md b/discussion.md  index 454d989..a820de2 100644  --- a/discussion.md  +++ b/discussion.md 
...
Anterior sacral meningocele develops as a result of a defect characterized by focal erosion or hypogenesis of segments of the sacrum with herniation of the meningeal sac through the defect into the pelvis. It accounts for about 5% of retrorectal masses, it is usually diagnosed in the second or third decades and are more prevalent in women.\cite{6828997} Presentation in elderly patients are less common, however it can occur as in the case described.  The presentation of anterior sacral meningoceles can be subtle. Therefore, the patient’s medical history and physical examination findings are critical diagnostic tools. The  patients may remain asymptomatic or present with nonspecific symptoms such as long-term constipation, urinary dysfunction, lower back pain, or perineal hypoalgesia.\cite{21977087}\cite{6470791} These symptoms may be due to direct compression of the herniated meningeal sac, spinal cord tethering, or sacral nerve root compression, diminished rectal and detrusor tone, or numbness and paresthesia in the lower sacral  dermatomes.\cite{11956924} Also fluid shifts between the sac and the spinal subarachnoid space can cause intermittent low or high-pressure headache, nausea and vomiting related to changes in body position.\cite{6828997} As a result of this nonspecific symptoms, the diagnosis can be difficult and occasionally can be confused with other entities.