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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. These lesions are difficult to diagnose without a strong suspicion. These lesions  rarely cause neurological complications, but obstetric problems, and bowel and bladder difficulties are common secondary conditions. Because these lesions usually do not regress spontaneously, surgical treatment is the standard for symptomatic or growing masses. The dural defect can be repaired with a variety of anterior or posterior 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 meningoceles was discovered, 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:*** _Meningocele, anterior, sacral, neurosurgery._