An Unusual Presentation of Anterior Sacral Meningocele: A Case Report and a Review of the Literature

Background Anterior Sacral Meningocele (ASM) is an extremely rare congenital anomaly which most medical practitioners may never come across in their life time. A rare case of Anterior Sacral Meningocele is reported with a review of the literature. Case Report A 31-years-old man was referred with an 8 month history of gradual abdominal distension. He was asymptomatic otherwise. He was found on examination to have a massive distension of his abdomen and his umbilicus was pushed-up. Dilated visible veins were observed in his groins. Abdominal palpation revealed a huge mass in the supra-pubic region extending up to the umbilical region. He had CT scan and MRI Scan which revealed: bilateral severe hydronephrosis and an anterior sacral defect affecting the distal sacrum, a huge, homogeneous cyst without enhancement diagnostic of anterior sacral meningocele arising out of the pelvis and extending into the abdomen and in continuity with the sacral defect. The diagnosis of Anterior Sacral Meningocele was established with CT scan and MRI Scan and the patient was referred to the Regional NeuroSurgical Centre Literature review revealed that a concave defect in the side of the sacrum (scimitar shaped sacrum) on plain x-ray of the pelvis is often diagnostic but CT scan and MRI scan would confirm the diagnosis. The goal of treatment of ASM is the obliteration of communication between the spinal sub-arahnoid space and the meningocele. Conclusion CT scan and MRI Scan are useful radiological methods by which the diagnosis of Anterior Sacral Meningocele can be confirmed.