APPROACH TO GIANT CYSTIC LESION IN CROHN'S DISEASE USING THE MODIFIED KRASKE PROCEDURE

Case Presentation A 45-year-old woman with ileocolonic Crohn's disease for 17 years, using certolizumab (discontinued infliximab 13 years ago due to anaphylactic reaction), previously underwent multiple abdominal surgeries due to enteric and colonic fistulas. She presented with a palpable abdominal mass, abdominal pain, and foul-smelling secretion from the anus. An investigation with pelvic MRI revealed an expansive formation of 17 cm extending from the pelvis to the mesogastrium, predominantly to the left, with T2 hypersignal and no post-contrast enhancement, of unknown etiology. Due to a history of previous laparotomies and intestinal fistulas, the decision was made to use the Kraske incision for a transperineal approach to the pelvic lesion under investigation. Intraoperatively, the cystic content was dark liquid, and there was glandular tissue inside, suspected to be ovarian tissue. Cytology of the surgery showed cystic, hemorrhagic, and benign fluid. The patient recovered satisfactorily and was discharged on the second postoperative day. The pathological examination of the lesion revealed ovarian tissue, diagnosing a left ovarian corpus luteum cyst.

Discussion The perineal approach is an option for retrorectal tumors, low perineal lesions, and cases where conventional laparotomy access is difficult. Due to the location and, primarily, the size of the lesions, some complications from the posterior approach may be observed, such as perforation of the neoplastic lesion, rectal perforation, and vascular and nerve damage. However, this approach has acceptable complication rates, short hospital stays, and quick recovery. The main complications of the approach are rectocutaneous fistulas, urinary dysfunction, and neurological issues.

Conclusion The posterior approach using the modified Kraske procedure can be used for giant pelvic lesions and yields acceptable results, making it a viable option for selected patients.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025