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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.    The diagnostic tests include several imaging studies like plain radiograph which shows the curved appearance of the residual sacrum, scalloped beneath the defect, this finding is considered as almost pathognomonic, and is present in 50% of cases.\cite{3335662} CT-scans are useful to display bony anomalies and lumbar erosions. Intrathecal contrast enhanced CT scanning is the diagnostic procedure of choice. Nevertheless, this method usually is descarted discarded  as is invasive and has the disadvantage of ionizing radiation. MRI is preferred as is a safe, rapid, and noninvasive.\cite{3418399} Abdominal ultrasound could reveal the presence of the intra-abdominal cystic abnormality, careful examination should be made to avoid misdiagnosis with cysts in other locations, a typical example of this is the confusion with ovarian cysts, as happened with our patient, and has been described in other reports.\cite{16673368}\cite{23486628} In our patient an invasive technique was executed with the consequent increased risk of producing a CSF leak into the abdominal cavity, although sometimes the fistula can occur by itself.\cite{21882098}\cite{18447698}\cite{20871432} Surgical options consist primarily of either an anterior transabdominal or a posterior transsacral approaches.