spinal meningocele is associated with spina bifida cysts and may occur at any age . however
, intrapelvic meningocele is rare and , without spinal compression , this type of meningocele does not cause any discomfort . for this reason , intrapelvic meningocele has not attracted much attention for a long time . here
, we report a case of an asymptomatic intrapelvic meningocele found incidentally during a sigmoidectomy due to megacolon in a 30-year old male patient .
a 30-year - old male , admitted because of constipation , was scheduled to undergo sigmoidectomy .
preoperative magnetic resonance ( mr ) scan indicated that a cyst was in front of the third sacral vertebrae ( s3 ) ( fig .
after sigmoidectomy , this cyst was resected . however , on the first postoperative day , 150 ml of amber liquid was drained from pelvic drainage tube . over the following several days
1c and 1d ) . because the patient had just undergone sigmoidectomy , conservative treatment consisting of three main steps was considered : drainage , anti - infection therapy ( cefpiramide combined with tinidazole ) and posturing by raising the position of the lumbosacral region to reduce liquorrhoea . at the beginning , we drained the cerebrospinal fluid ( csf ) via a pelvic drainage tube .
however , because the volume still exceeded 150 ml / d , we placed another drainage tube into the subarachnoid space . on the first day , approximately 300 ml csf drained from the subarachnoid tube , and 50 ml drained from the pelvic cavity . over the following three days , the volume of liquid from the pelvic cavity began to reduce generally .
the subarachnoid drainage tube was removed on the fourth day and there was no liquorrhoea over the next two days .
mr scan reveals the presence of a cyst 3 cm in diameter ( arrow ) in front of s3 in a 30-year - old male patient ( a : coronal section ; b : median sagittal section ) .
histological examination ( c : 40 ; d : 100 ) showed that the cyst was mixed with nerve collagen tissue ( h&e ) .
intrapelvic meningocele is defined as a csf - filled sac within the spinal meningeal wall which protrudes into the intrapelvic cavity through an enlarged intervertebral foramen or bone defect .
acquired meningocele is relatively common as a laminectomy complication , while congenital meningocele is commonly associated with neurofibromatosis , .
the clinical manifestation of an intrapelvic meningocele is closely related to its size and relationship with surrounding structures .
it may include back pain , urinary and fecal incontinence , and lower limbs weakness or paralysis
. a small lesion may be asymptomatic and discovered incidentally , as it was in our case . for small- and medium - sized lesions , the most common surgical management is resection of the meningocele and repair of the dural defect through laminectomy , . in this case ,
surgery was performed with removal of the meningocele pouches and shunting of the cyst to the subarachnoid region . however , liquorrhoea occurred after the operation .
although liquorrhoea is a common occurance with cystectomy , it may result in infection of the central nervous system .
specific posture and drainage in combination with anti - infection therapy were performed instead of surgery .
this conservative method can also treat liquorrhoea effectively and at the same time help patients avoid a second operation .
 asymptomatic intrapelvic meningocele is rare . here , we report the case of a 30-year - old chinese man who underwent sigmoidectomy due to megacolon . during the operation , 
 an intrapelvic cyst was found and resected . 
 meningocele was confirmed by histological examination . 
 the patient recovered well postoperatively with the exception of liquorrhoea . 
 conservative therapy was initiated , including draining , anti - infection and specific posture maintenance . during the following week 
 , liquorrhoea was generally relieved and the patient was discharged . 
 this is the first known report of liquorrhoea associated with intrapelvic meningocele resection successfully treated by conservative therapy . 
 our case indicates that conservative treatment may be considered for similar cases so that a second surgery is avoided . 
INTRODUCTION
CASE REPORT
DISCUSSION