We report a case of sacrococcygeal meningocele simulating a sacrococcygeal teratoma. Likewise, there are a discussion of the pathophysiology and surgical approach of these types of lesions. We present a case of an exceptionally large posterior coccygeal meningocele of a newborn, and show the interest of radio-echographic couple and the interest of a management surgical approach. This was a case of posterior coccygeal meningocele, in a 10-day-old newborn born at term, with no known maternal history other than active smoking. The clinical examination finds a eupneic newborn, presents a median mass at the level of the sacrococcygeal part, of soft consistency, painless, without signs of inflammation, of normal skin, volume 18 x 21 x 19 cm, with positive transillumination test, no sensitivomotor deficit of both limbs, no other malformative anomalies detected clinically, but presence of anal atony and vesico-anal inconstancy. The ultrasound reveals a fluid formation containing small cysts. The x-ray revealed the absence of the posterior coccyx arch, an appearance in favor of a posterior sacrococcygeal meningocele. The surgery consisted of a meningocele cure followed by a buttock plasty. The postoperative follow-up was simple, without infectious or metabolic complications. Standardization and improvement of accessibility to ultrasound and obstetric MRI could improve the antenatal diagnosis of this pathology in Madagascar.