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# Conclusions  We present an interesting a  case of a large anterior sacral meningocele. meningocele with some interesting nuances.  Although meningoceles are rare, they the diagnosis sometimes  can have serious complications and therefore be challenging, the diagnosis  should not always  be overlooked. kept in mind in order to avoid erroneous diagnoses that may expose the patient to unnecessary surgical procedures.  Imaging is critical, but a carefully obtained medical history can reveal important clues. Surgery is generally advised, and multiple approaches are available. Each approach must be carefully considered and the decision made on the basis of the specific surgical goals, on a case-by-case basis. Although Usually  the posterior approach remains the treatment of choice for mostlesions, we believe that the anterior laparotomy provides excellent exposure and is a safe alternative approach for the treatment of large  lesions. Patients with these lesions should be cared for by a multidisciplinary teamthat involves neurosurgeons and colorectal surgeons initially and then a genetic specialist and obstetrician  for further pre and postoperative  complete evaluation postoperatively. evaluation.