Presacral, Retrorectal Dermoid Cyst in a Female Patient - Case Report
Date Issued
2012-10
Author(s)
Milev, Ilija
Abstract
The retrorectal tumors are well defined, classified and understood pathological entities in the
literature but in practice they represent very unusual and infrequent pathology. We are presenting
a case from the group of dermoid congenital retrorectal cysts which at first manifested itself
clinically as inflamatous retrorectal cyst that had spontaneously rupture in the postanal space with
local (tumor, dolor, calor, rubor, function laesa and fluctuation) and systemic signs of infection
(fever, rise temperature, leukocytosis). On physical examination there was typical postanal dimple
which gives a picture of “double anus” on inspection. On DRE there was retrorectal soft tumor
with compression of the anorectum. Diagnosis was confirmed with MRI and fistulography. After
a palliative treatment for abscending cyst with incision, Penrose drainage and daily washings with
antiseptic solutions the patient was transferred in specialized institution - the Clinic of Digestive
surgery at the Medical Faculty in Skopje for definitive treatment. The operation was performed
with the patient in jack-knife position with conventional preparing of the colon and prophylactic
antibiotic regiment started preoperatively. An on table anoscopy was performed at first which
sowed typical mammilla at the internal opening of the fistulous communication of the cyst with
the rectum about 3 cm above the posterior crypt of Morgagni. We started with excision of the
external opening, and preceded with whole excision of the pericystic granulomatous tissue about
14 cm in length till the presacral point. The fistulous communication was excised completely and
the rectum was sutured in two layers with separate sutures. The wound was laid open and the
patient was discharged on the 5-th postoperative day. About one month the wound was treated
with daily washings with antiseptic solutions and after that one month with only water. After two
mounts the defecation is normal, the wound is sealed and there are no signs of inflammation and
secretion locally. The retrorectal tumors are difficult for treatment as well as for diagnosis where
even punctional biopsy is not recommended so they should be treated in specialized institutions
by experienced surgeons from the moment of diagnosis to the definitive surgical treatment.
literature but in practice they represent very unusual and infrequent pathology. We are presenting
a case from the group of dermoid congenital retrorectal cysts which at first manifested itself
clinically as inflamatous retrorectal cyst that had spontaneously rupture in the postanal space with
local (tumor, dolor, calor, rubor, function laesa and fluctuation) and systemic signs of infection
(fever, rise temperature, leukocytosis). On physical examination there was typical postanal dimple
which gives a picture of “double anus” on inspection. On DRE there was retrorectal soft tumor
with compression of the anorectum. Diagnosis was confirmed with MRI and fistulography. After
a palliative treatment for abscending cyst with incision, Penrose drainage and daily washings with
antiseptic solutions the patient was transferred in specialized institution - the Clinic of Digestive
surgery at the Medical Faculty in Skopje for definitive treatment. The operation was performed
with the patient in jack-knife position with conventional preparing of the colon and prophylactic
antibiotic regiment started preoperatively. An on table anoscopy was performed at first which
sowed typical mammilla at the internal opening of the fistulous communication of the cyst with
the rectum about 3 cm above the posterior crypt of Morgagni. We started with excision of the
external opening, and preceded with whole excision of the pericystic granulomatous tissue about
14 cm in length till the presacral point. The fistulous communication was excised completely and
the rectum was sutured in two layers with separate sutures. The wound was laid open and the
patient was discharged on the 5-th postoperative day. About one month the wound was treated
with daily washings with antiseptic solutions and after that one month with only water. After two
mounts the defecation is normal, the wound is sealed and there are no signs of inflammation and
secretion locally. The retrorectal tumors are difficult for treatment as well as for diagnosis where
even punctional biopsy is not recommended so they should be treated in specialized institutions
by experienced surgeons from the moment of diagnosis to the definitive surgical treatment.
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