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Pouch of Douglas hernias are uncommon forms of pelvic hernia. They are most commonly seen in multiparous, elderly women and those having undergone previous pelvic surgery (Stamatiou et al. in Am Surg 76(5):474-479, 2010). Herein, we present a case of a 77-year-old female presenting with groin pain due to a Pouch of Douglas hernia. She had no previous abdominal or pelvic surgery. This was repaired via a trans-abdominal pre-peritoneal approach and the patient's symptoms resolved. To our knowledge, this is the first case report in the literature of an idiopathic Pouch of Douglas hernia managed laparoscopically.

Anterior sacral meningocele is a rare cause of a pelvic mass. Herein the authors describe the case of a young patient presenting with chronic pelvic pain undergoing diagnostic laparoscopy. She was found to have a retrorectal mass confirmed as an anterior sacral meningocele on subsequent MRI. The authors explore the case, describe a method of intraoperative management to minimize the risk of severe complications and include a discussion of the differential diagnosis. Central to this is an emphasis on advocating a cautious approach when confronted with an incidental unknown pelvic mass, as deleterious consequences may occur from biopsy of such a lesion., (Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.)