Challenges in Retrorectal Cysts: Is Preoperative Diagnosis Essential?

Abstract

Developmental cysts are a subgroup of perirectal cysts seen extremely rarely. They have no symptoms in 50% of cases, and mostly occur among middle-aged women. The ratio of male to female is approximately 1/3. In the differential diagnosis, malignancies and pilonidal cysts are common. Although they usually occur as benign lesions, 30% of cases are reported as malignant in literature. Preoperative diagnosis is quite challenging, but may be essential for appropriate treatment. The main treatment is surgical removal of the entire cyst for the prevention of complications and the potential for malignancy. In addition to the trans-sacral or perineal approach, anterior laparoscopy can be performed as an optional surgical technique. Herein, we report two consecutive patients with two different developmental cyst pathologies. A 17-year girl, who had no specific symptoms for a retrorectal giant cyst, was admitted to this clinic because of pilonidal cyst disease. A giant retrorectal cyst was diagnosed through pelvic MRI,which was performed upon her reporting a mild fullness feeling. The other cyst was diagnosed in a 30-year woman who had mild gastrointestinal symptoms that could not be related to the cyst. Both underwent surgery via the trans-sacral approach. The cysts were completely removed without abdominal intervention. Key Words: Epidermoi cyst, Pilonidal cyst, Tail-gut cyst, Retrorectal Space.