Anterior Sacral Meningocele With Presacral Cysts: Report of a Case

Abstract

Anterior sacral meningocele is a rare anomaly most frequently presenting as a presacral mass. Since the first description in 1837, approximately 150 cases have been reported. The case presented is a 37-year-old female in whom an asymptomatic presacral mass was discovered during her first delivery. Because normal delivery was impossible, a cesarean section was performed. A year later, in a regional hospital a "cystic presacral tumor" was treated with biopsy and drainage. Four years later, she developed constipation caused by perineal compression for which she was admitted to our department in which two anterior presacral cysts were excised. The recovery was complicated with meningitis, which was successfully treated with antibiotics. Whenever a presacral mass is found, anterior sacral meningocele has to be a diagnostic consideration. The symptoms are usually related to the compression on rectum, bladder, and sacral nervous plexus. Rectal examination and radiography of the pelvis with the sacral bone showing the "scimitar sign" are the main diagnostic methods. Myelography, computed tomography, and magnetic resonance imaging are the best methods for identifying the precise anatomy of sacral meningocele and for proper planning of the operation. Transvaginal or transrectal aspiration and drainage are not advised, because they may result in a lethal outcome caused by sepsis.

An elusive pelvic cyst: a case report of an anterior sacral meningocele

“…Before the 1960s, there was a very high surgical mortality reaching 40% due to mistakes in the preoperative diagnosis and limited imaging techniques [1]. As shown in our case report, one must remain vigilant when dealing with a presacral mass and always consider the possibility of ASM.…”

“…In women, ASM can lead to birth dystocia [8]. Patients can also present with recurrent meningitis; headache during strain, defecation, and coitus [1] and low-pressure headache in response to a change in posture; or low-back pain [5].…”

“…The patient was discharged from the HDU on day 5 after the operation and went home the next day. Prior to discharge, she was counseled regarding the possibility of the hereditary nature of ASM [1] and screening of her child was recommended. At 6 weeks post-operatively, she had made an excellent recovery with only a small area of numbness on the left side of her buttock.…”

“…Anterior sacral meningocele (ASM) is a congenital lesion resulting from a herniation through a defect on the anterior surface of the sacral bone [1]. It is a rare anomaly and only about 200 cases have been reported in the literature since its first description in 2003 [2].…”

Currarino Syndroma, initially misdiagnosed and treated like megacolon congenitum

“…Although the triad of symptoms were described by Kennedy in 1926 [7], to date only 200 cases were described in the literature, so the Currarino's syndrome is rarely mentioned in the surgical community. Pathogenetic cause of defecation disorder can be caused by anteposition of the anus, compression of spinal nerve roots, or compressive presacral mass effect [10,11].…”