Published in:
03-05-2023 | Magnetic Resonance Imaging of the Spine | The Last Image
Laparoscopic resection of a retrorectal cystic tumor
Published in: Techniques in Coloproctology | Issue 12/2023
Login to get accessExcerpt
Tumors arising in the retrorectal space are rare, more commonly affecting women between 40 and 50 years of age [1]. The diagnosis is often incidental, with 26–50% of cases being asymptomatic. Epidermoid cysts are uncommon congenital cystic lesions [2]. In centers with adequate expertise, surgical treatment is safe and justified given the risk of malignant degeneration, estimated to 31% and 9% for solid and cystic lesions, respectively [3]. Compared to robotics, laparoscopic approach allows shorter operating time [4] (Fig. 1).
Fig. 1
A 50-year-old lady presented to the outpatient clinic with a 1-month history of worsening lower back pain. Magnetic resonance imaging of the spine demonstrated a liquid mass with clear-cut edges adhering to the anterior margin of the coccyx with a craniocaudal diameter of 4.5 cm (a, sagittal view). Diagnostic workup also included transrectal ultrasound and computed tomography (CT) with contrast medium. The latter revealed a cystic lesion of 4 × 3 cm, adherent to the coccygeal metameres, with thin walls and homogeneous contents (axial view, b). A laparoscopic excision of the retrorectal cyst was planned. The induction of the pneumoperitoneum was performed with the Hasson technique at the supraumbilical site, with four other trocars positioned under vision: one 10 mm in the right iliac fossa, one 10 mm in the right flank, one 5 mm in the left flank, one 5 mm suprapubic. The left uterosacral ligament was then incised with subsequent dissection of the perirectal adipose tissue up to the level of the levator plane (c, narrow space between the rectal wall [1], the cyst [2], and the levator ani plane [3]), thus reaching and completing the excision of the cystic mass (d). The definitive histological examination revealed unilocular cysts lined by keratinizing squamous epithelium, lacking other cellular differentiation (e, f). The postoperative course was uneventful and the patient was discharged 3 days after surgery. No evidence of recurrence was noted up to 6 months postoperatively
× ![]()
…