Unusual cause of defecation disturbance: a presacral tailgut cyst

The aim of this study was to provide an overview of the literature on Tailgut cysts (TGCs) arising in the presacral space.

We present a new case of presacral TGC and a literature review of English-language studies of presacral TGCs, accessed through the PubMed and Google Scholar databases. Keywords used were presacral or retrorectal tailgut cyst, presacral mucus-secreting cyst, retrorectal cystic hamartoma, retrorectal tumor, vestigial retrorectal or presacral cyst, and presacral cystic tumor.

A 29-year-old woman presented to our Clinic with defecation disturbance caused by a presacral TGC. Our literature review resulted in the inclusion of 94/111 articles and 155/332 described cases (129 women, 26 men; age, 0-80 years) of presacral TGC in this study. Although most patients presented with complaints such as rectal bleeding, rectal fullness, perianal pain, constipation, and pain reflected to the back, some asymptomatic cases were identified incidentally and others were detected during the investigation of atypical complaints such as pilonidal abscess, sinus, vaginal obstruction, and perianal abscess. Malignant transformation was found in 47/332 cases, including adenocarcinoma (n = 26); carcinoid tumor (n = 16); endometrioid, adenosquamous, and squamous carcinomas; sarcoma; and paraganglioma.

The high rate of malignant disease development from TGCs, which comprise a significant proportion of presacral masses; the development of significant postoperative recurrence, causing atypical conditions such as perianal fistula; and the high rates of infection due to partial resections make it essential to perform complete tumor resection with adequate margins.