A 53-year-old male presented with an abdominal mass and urinary disturbance. Plain pelvic X-rays revealed a scimitar deformity of the sacrum. Computed tomography (CT) of the abdomen and lumbosacral spine showed a 13 X 17 X 17 cm, hypodense, cystic mass. Metrizamide myelography disclosed a bony defect at the S2 level through which contrast material entered the pelvic cyst, confirming the diagnosis of anterior sacral meningocele. Magnetic resonance imaging demonstrated the extent of the abdominal mass and its communication with the thecal sac through the anterior sacral defect. The patient underwent surgery via the transabdominal approach. The mass was extremely adherent to the intestine and it was difficult to reach the stalk of the sac. The wall of the meningocele was resected to the extent possible, and was tightly sutured following a meningocele-peritoneal shunting procedure. Postoperatively, the patient was neurologically normal, but 4 months later he was readmitted because of headaches and clouding consciousness. CT showed bilateral chronic subdural hematomas. Following their evacuation, the patient recovered uneventfully. The clinical and neuroradiological features and the surgical approaches to anterior sacral meningoceles are discussed.