Successful excision of a retrorectal cyst through trans-sacral approach: A case report

Retrorectal cysts are rare congenital cystic lesions usually diagnosed in middle-aged women. They are generally asymptomatic; however, local pressure may result in complications. Pain or discomfort in the pelvic, sacral, lower back or perianal area are the most common symptoms. The diagnosis is difficult, and multidisciplinary management is required. An epidermoid cyst is the most common type. Surgical resection is the main treatment, and 3 operative approaches are commonly used: abdominal, trans-sacral, and combined abdominosacral. The selection of the approach depends on the nature and location of the lesion. Here, we present a case that demonstrates the trans-sacral approach to a retrorectal cyst is a feasible option in terms of safety and minimal invasiveness for selected patients with this rare type of retrorectal cystic lesion.

A 38-year-old woman with no comorbidities incidentally showed a retrorectal cyst on magnetic resonance imaging performed during pregnancy. The patient underwent surgical resection under general anesthesia, trans-sacral incision was performed, the posterior rectum exposed, and the cyst removed. No complications were seen in the postoperative period.

Posterior trans-sacral resection (Kraske) is preferred for patients with posterior retrorectal cyst because it provides adequate exposure.

Posterior trans-sacral resection allows proximal extension for elimination of the infection and in cases of adherence of the cyst to surrounding structures or in malignancy, which require en bloc resection.