An Asymptomatic Large Anterior Sacral Meningocele in a Patient with a History of Gestation: A Case Report with Radiological Findings

Abstract

Anterior sacral meningocele is characterized by herniation of the meningeal sac due to a developmental bone defect in the front of a sacrum bone. It was first described in 1837. The sacral meningocele may be congenital or acquired. It is usually discovered during a rectal or pelvic examination as a cystic lesion or discovered incidentally. Most of the symptoms are due to compression on the adjacent organs. In this paper, we present a case of an asymptomatic female patient who had a pelvic cyst detected during a routine obstetric ultrasound examination. We show radiological findings of the detailed postpartum evaluation of the cyst, which led to detection of sacral agenesis, huge anterior sacral meningocele, and significant arcuate uterus.

Anterior Sacral Meningocele Masquerading as an Ovarian Cyst: A Rare Clinical Presentation Associated with Marfan Syndrome

“…ASMs account for approximately 5% of retrorectal masses and commonly present in the second and third decades of life, more often in women, at a ratio 4:1. 2 , 6 They may be asymptomatic or may present with a pelvic mass causing symptoms in two-thirds of cases related to compression of surrounding structures by the herniated meningeal sac; neurological symptoms due to spinal cord tethering; or compression on sacral nerve roots including urinary dysfunction, dysmenorrhea, dyspareunia, constipation, perineal hypoalgesia, lower back pain, sacral numbness, and paresthesia in the lower extremity; central neurological symptoms including headache and nausea secondary to increased intraabdominal pressure or its complications in the form of meningitis. 6-9 Our patient had no symptoms other than abdominal distention despite a significantly large ASM.…”

“…A detailed clinical examination and further imaging studies with computed tomography (CT) and/or MRI may be required to differentiate ASM from other causes of cystic presacral masses, including ovarian cyst, rectal duplication cyst, neuroectodermal cyst, perineural cyst, teratoma, dermoid/epidermoid cysts, hydatid cyst, pyogenic abscess, lymphangioma, and aneurysmal bone cyst. 6 , 7 …”

“… 4 However, MRI may fail to demonstrate narrow subarachnoid communications of a small-necked lesion with the subarachnoid space in which CT myelography may be useful. 6 , 7 …”

Anterior sacral Meningocele Associated with Tethered Cord Syndrome Presenting with Constipation: US, CT, MRI and X-Ray Findings

“…ASM may be mistaken for a tail gut duplication cyst, a presacralneurenteric cyst, a sacrococcygealteratoma, a hydatid cyst, or an ovarian cyst [5] [20] [21]. The demonstration of the continuation of the presacral cyst with the thecal sac provides this differentiation.…”

Differential diagnosis of anterior sacral meningocele during the evaluation of post-hysterectomy pelvic collections

“…ASM is a rare form of spinal dysraphism, in which the meningeal sac herniates into the presacral space ( 4 , 5 ) . It accounts for approximately 5% of all retrorectal masses and is more prevalent in women ( 6 ) .…”