Anterior Sacral Meningocele

pubs.rsna.org/doi/10.1148/58.1.104

Robert J. Calihan

Author Affiliations
Published Online:Jan 1 1952https://doi.org/10.1148/58.1.104

Abstract
Anteriorsacral meningocele is a relatively rare entity which, because of varying signs and
symptoms, may be a problem for the surgeon, the gynecologist, the neurologist, the
urologist, the pediatrician, or the neurosurgeon. It is the radiologist, however, who
ultimately is required to make or confirm the diagnosis.

A review of the literature relating to anterior sacral meningocele was made by Coller and
Jackson in 1943 (1); they found 22 previously reported cases and added 1 of their own.
Since then 3 additional cases have been contributed by Shidler and Richards (2), 1 by
Ingraham and Hamlin (3), 2 by Flickinger and Masson (4), 1 by Alexander and Stevenson
(5), 1 by Brown and Powell (6), and 3 by Sherman, Caylor, and Long (7). A comprehensive
review of the world literature was provided in 1949 by Eder (8), in which he tabulated 45
cases including 1 of his own. (Eder did not list the case reported by Brown and Powell, and
Sherman, Caylor, and Long published their 3 cases in 1950, subsequent to Eder's study.) It
is the purpose of this paper to describe 3 cases seen in the Strong Memorial Hospital
(Rochester, N. Y.). They bring to at least 52 the examples of anterior sacral meningocele so
far recorded.

Anterior sacral meningocele is a congenital anomaly characterized by agenesis of a part of

the anterior portion of the sacrum, herniation of meninges through the defect, and
formation of a hernial sac in the pelvis. The presence of the anterior defect differentiates
this anomaly from the more common posterior sacral meningocele caused by failure of
fusion of posterior sacral arches. In the latter condition, propulsion of the hernial sac
posteriorly permits the formation of an easily recognized protuberance of varying size on
the posterior body wall. With anterior sacral meningocele, there is no external
manifestation of the anomaly and the diagnosis is made on the basis of clinical suspicion
and x-ray confirmation.

Symptoms, if any, are usually secondary to the pressure of the meningocele on the rectum
and indirectly on the urinary bladder and other pelvic organs; constipation, frequency,
urgency, and dysuria are the most common complaints. Dysmenorrhea and dyspareunia
with headache may be present in women. Headache may also occur during and following
bowel evacuation. The headache is presumably the result of pressure on the pelvic mass
which, transmitted through the spinal canal, creates temporary alteration of the intracranial
pressure. Physical examination may reveal the presence of a fluctuant mass high in the
posterior rectal wall, or the examination may be negative.
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Therapy depends on the seriousness of the symptomatology. The only effective treatment
is surgical amputation of the hernial sac. This, however, is a major procedure and is not
indicated unless the symptoms are so severe as seriously to incapacitate the patient.

Article History
Accepted: June 1951
Published in print: Jan 1952

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