Case Presentation An 11-year-old patient presented with intense colicky abdominal pain that worsened
during defecation, along with a 4 kg weight loss over the past month. She had a prior
hospitalization for abdominal pain, no family history of inflammatory bowel disease,
but a maternal history of constipation and hard stools. Imaging exams, including ultrasound
(US) and CT, revealed significant small bowel distension, an enlarged right adnexa
for her age with multiple follicular cysts, and a thick-walled cystic lesion with
regular contours located posterior to the rectum, displacing its lower third anterolaterally
to the right. MRI was performed for surgical planning and confirmed a solid-cystic
extraperitoneal lesion in the presacral region, with no evidence of invasion into
adjacent structures. Surgical excision of the lesion was conducted using a posterior
approach with coccyx fracture during the procedure. Histopathological examination
confirmed the diagnosis of a retrorectal hamartoma ("tail gut cyst"). Postoperatively,
the patient reported controlled pain, functional bowel habits, but complained of weakness.
Discussion Retrorectal hamartomas ("tail gut cysts") are rare congenital lesions originating
from embryological remnants of the hindgut. They are more common in middle-aged women,
typically between 30 and 60 years. Clinical presentation ranges from asymptomatic
to significant proctological symptoms, depending on the lesion's size and location.
In this case, the patient experienced symptoms such as intense abdominal pain, vomiting,
and significant weight loss. Surgical resection, crucial to prevent future complications
such as infections, bleeding, or malignant transformation, was performed via a posterior
approach (Kraske incision) with coccyx fracture to access the lesion site.
Conclusion This case highlights the importance of a comprehensive differential diagnosis in
pediatric proctological patients with chronic abdominal pain and weight loss. Advanced
imaging techniques combined with histopathological evaluation are essential for accurate
diagnosis and therapeutic planning. Complete surgical removal of retrorectal hamartomas
is recommended due to their potential for complications, and adequate postoperative
management is crucial for the patient’s full recovery.
