Tailgut Cyst-Gynecologist's Pitfall: Literature Review and Case Report

Abstract

Background and Clinical Significance: Retrorectal cystic hamartomas ("Tailgut cysts") are rare developmental cysts that appear in the retrorectal space, arising from aberrant remnants of the post-anal primitive gut in case of an incomplete embryogenetic involution. Case Presentation: We present the case of a 30-year-old woman with a history of chronic lower abdominal pain. Other digestive symptoms, like rectal fullness, constipation, pain on defecation, rectal bleeding or genitourinary obstruction symptoms, were not associated. During a period of 3 years, she underwent several surgical procedures for ovarian cysts, without relieving the symptomatology. A computed tomography (CT) scan showed a presacral tumor with a right pararectal development. A surgical resection of the lesion using an anterior approach was performed, with the final pathological diagnosis of a retrorectal cystic hamartoma ("tailgut cyst"). Conclusions: This case underlines the fact that retrorectal masses can be challenging to diagnose, and tailgut cysts must be taken into consideration in cases of perirectal tumors in patients with a history of multiple failed procedures and surgeries.

Keywords: chronic pelvic pain; retrorectal hamartomas; retrorectal space; tailgut cyst.

Figure 1

Contrast computed tomography showing the presacral tumor with right pararectal development; (a) axial view, arterial phase; (b) coronal view, arterial phase; (c) sagittal view, native phase.

Figure 2

Overview of a large portion of the cyst wall (HE staining, ×40).

Figure 3

Cyst wall (detail): fibrovascular tissue with smooth muscle bundles lined by stratified squamous epithelium (HE staining, ×100).

Figure 4

Cyst wall (detail) with rare inflammatory cells under the epithelium (HE staining, ×100).

Figure 5

Flowchart depicting the search strategy employed to find the studies included in the review (following 2020 PRISMA guidelines).