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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.  They may be asymptomatic or present as 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.\cite{11956924} As a result of this nonspecific symptoms, the diagnosis can be difficult and occasionally it can be confused with other entities such as ....  > ASM is either asymptomatic or  manifested by nonspecific symptoms as a result of pressure  on the viscera such as constipation, urinary problems,  dysmenorrhea, or pain in the lower back or pelvis  [4,5]. Furthermore pressure may be exerted on nerve  roots, resulting in sciatica, compression,  diminished rectal and detrusor tone, or numbness and paresthesia in the lower sacral  dermatomes. In addition, 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 [2]. Very As a result of this nonspecific symptoms, the diagnosis can be difficult and occasionally it can be confused with other entities such as ....  - confusion con quistes ovaricos  - approaches