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# Discussion  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. The patients may remain 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, diminished rectal and detrusor  tone, or numbness and paresthesia in the lower sacral 
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  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 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. The main goal of surgery should be to safely disconnect the cyst from subarachnoid space to prevent further enlargement, thereby reducing the compression of nearby structures.  The anterior transabdominal approach \cite{16793455}  Several reports have stressed the advantages of the posterior transsacral technique, which offers (citas), anterior transabdominal approach \cite{16793455} (citas).