Rare Case of Anterior Sacral Meningocele in a 30‐Year‐Old Male: Surgical Excision Using the Posterior Sagittal Approach

Anterior sacral meningocele (ASM) is an uncommon congenital spinal abnormality in which the meningeal sac herniates through an abnormality in the anterior sacrum into the presacral space. It is more observed in females and usually asymptomatic; large ASMs may cause pressure effects on nearby pelvic structures. A 30-year-old male presented with prolonged constipation and recurrent episodes of urinary retention, which developed to complete urinary obstruction. Ultrasound demonstrated a large presacral cystic mass, and MRI confirmed the diagnosis of an ASM. Pelvic x-ray revealed the classic Scimitar Sign. Neurological examination showed no abnormalities. The patient was subjected to surgical excision through the posterior sagittal technique. Intraoperative steps consisted of laminectomy, durotomy, sac decompression, and fascial graft repairing. After the procedure, the patient experienced a smooth recovery with notable improvement in bowel and urinary symptoms. ASM is an uncommon etiology of pelvic mass and neurogenic bladder symptoms occurring in adults. This case underscores the diagnostic importance of MRI and pelvic X-ray, and also supports the posterior sagittal approach as an effective, low-complication surgical approach. ASM should be taken as a differential diagnosis for adult patients having symptoms of chronic constipation and urinary retention. Prompt imaging and surgical treatment can notably improve outcomes.