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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.Due to these symptoms and the presence of a growing mass a new surgical procedure consisting in a posterior sacral laminectomy and ligation of the meningocele cyst was proposed. The patient was very unkeen in further surgery, particularly after the results of the previous ones, however, she was so ill that she accepted surgery.   The procedure was performed in a prone position, a sacral laminectomy was executed, the dura was so thin that it kept tearing continuously, after complete dural exposure the anterior sacral defect lean out, subsequently to ligation of the neck, both an anterior and posterior dural patch was placed in order to prevent further leaks of CSF, a left drainage was placed. The patient remained in bed rest for about 5 days, with further improvement of the symptomatology, she remained hospitalized for 7 days and was discharged without any complications.  At 3 months post surgery an MRI (Figure 2.) was made, revealing complete remission of the anterior sacral meningocele. Although the abdomino-pelvic symptoms disappear, the sciatic and lumbar pain remained with lower intensity.