CYSTIC RETRO-RECTAL HAMARTOMA (TAILGUT CYST) WITH SURGICAL TREATMENT VIA POSTERIOR ACCESS: A CASE REPORT

Case Presentation A 45-year-old female patient with no comorbidities, with a family history of anal cancer, was admitted with complaints of spontaneous pain in the hypogastric region, buttocks, and lower limbs, worsening progressively when walking. She reported daily bowel movements with well-formed, occasionally dry stools, and three episodes of hematochezia during the period. A colonoscopy performed a year and a half before admission identified a 4mm sessile polyp classified as Paris 0-Is, and the pathological exam showed an inflammatory pseudopolyp. During follow-up, a pelvic MRI revealed a circumscribed cystic image located in the median retro-rectal region, in close contact with the levator ani muscle, with probable hematic and hyperproteic content, measuring 2.1 × 2.5 × 2.9 cm, suggestive of Cystic Hamartoma (HC). The patient underwent resection via posterior retro-rectal access using the Kraske approach, with good postoperative recovery, and the final pathological result confirmed the diagnosis of HC.

Discussion Presacral tumors are rare and difficult to diagnose, occurring at a rate of 1 patient per 40,000-60,000 in the general population. Clinical symptoms are typically related to pelvic pain that worsens when sitting and improves when standing. Other symptoms may include fecal and urinary incontinence, constipation, and sexual dysfunction, due to involvement of the sacral nerve in more advanced tumors. HC (Tailgut Cyst) is a type of congenital lesion originating from the primitive hindgut and is more prevalent in females. This lesion is well-defined, homogeneous, and does not communicate with the rectal lumen, and can be either unilocular or multilocular. Advances in diagnostic methods and imaging studies, particularly MRI, have led to more accurate diagnoses and better treatment outcomes for patients with these tumors.

Conclusion HC are rare and difficult-to-diagnose lesions that may undergo malignant transformation in some cases. Current surgical resection techniques provide ideal therapeutic results, with a focus on preserving the sphincter and nerve plexus, offering preservation of fecal continence and, ultimately, improving postoperative quality of life.

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

Publication History

Article published online:
25 April 2025