Retrorectal epidermoid cyst--a rare entity: the effectiveness of a transperineal posterior approach

BACKGROUND: Presacral cysts are rare presacral tumours. The ideal treatment is a matter of debate. METHODS: We report the case of a 39-year-old woman referred to our institution for a presacral mass, casually diagnosed during a pelvic ultrasound examination. Ano-rectal examination and MRI revealed the presence of a mass (53 x 52 x 54 mm) in the retrorectal space, located between the right pyriform muscle and the lateral rectal wall, without signs of invasion of the surrounding structures. We performed the intervention with a transperineal approach in the jack-knife position. RESULTS: Operating time was 20 minutes. During the postoperative period no complication was observed. The patient was discharged in good general condition. No complication occurred during 48 months follow-up. CONCLUSION: We chose this approach, because, although alternative approaches are described in the literature, they are based on a small number of patients, even if showing encouraging results. We found the posterior procedure safe, feasible and effective.