Sacral Agenesis Type II in a 12-Year-Old Patient: A Delayed Presentation in a Low-Resource Setting

Abstract

Sacral agenesis is a rare congenital anomaly with varying severity, from partial sacral hypoplasia to complete absence of the sacrum and coccyx. Often linked to maternal diabetes, it can cause significant neuromuscular and genitourinary complications. We present a 12-year-old female patient from a low-resource setting with lifelong lower limb weakness and urinary incontinence, born to a diabetic mother and diagnosed with sacral agenesis Type II. Financial constraints limited further management. This case highlights the challenges of delayed diagnosis and treatment, underscoring the need for improved healthcare access to ensure timely intervention for congenital disorders, particularly in underserved populations.

Keywords: caudal regression syndrome; coccyx; sacral agenesis; sacrum; socio-economic factors.

Figure 1. Frontal radiograph of the pelvis showing non-visualization of the (A) sacrum and (B) coccyx.

Figure 2. (A) Sagittal, (B) coronal, (C) axial, and (D,E) 3D reconstructed CT images showing bilateral iliac bones articulating with the S1 vertebra with reduced distance between them. There is an absence of the rest of the sacral vertebrae and coccyx.

Green lines: Bilateral iliac bones articulating with the S1 vertebra, with reduced distance between them. Red circles: Absence of the rest of the sacral vertebrae and coccyx.

Figure 3. (A) Sagittal T2WI showing disc desiccatory changes at the L3-L4, L4-L5, and L5-S1 levels with reduced disc height at the L5-S1 level. (B) Sagittal T2WI showing a hypoplastic spinal cord.

T2WIs: T2-weighted images