The special finding of three-dimension high-resolution manometry in the diagnosis of presacral epidermoid cyst

Excerpt

A 35-year-old woman presented with pain in the pelvic floor and right buttocks for one month. Digital examination of anorectum showed remarkable mucosal protrusion in the right rear wall of rectum about 3 cm distance from the anal margin with pain on press. The magnetic resonance image of pelvic floor showed a cystic short T1 long T2 signal image adjacent to rectum in front of the sacrum (Fig. 1). The three-dimension high-resolution manometry (3D-HRM) of anorectum showed a blue irregular low-pressure area both at rest (Fig. 2) and squeeze (Fig. 3) state which indicated that the sphincters of anorectum were pressed by presacral or anal peripheral tumor. The location of this low-pressure area (from the 6 to 9 o’clock direction in lithotomy position) revealed that the tumor was located in the right rear wall of rectum. The longest diameter (2.5 cm) and the widest diameter (1.5 cm) of this low-pressure area also indicated that the diameter of the tumor was approximately 2.0–2.5 cm, while the exact diameter of the tumor was 2.5 cm approved by MRI. It is quite interesting to use functional test (3D-HRM) to confirm anatomical abnormality which always diagnosed by radiographic inspection. After the laparoscopic anterior sacral tumor resection, the pathological result of this tumor is epidermoid cyst. After recovery from the operation one month later, the patient did the 3D-HRM of anorectum again, the blue irregular low-pressure area vanished (Fig. 4), which further confirmed that the low-pressure area was caused by the pressing of the tumor. So 3D-HRM technique would be helpful to find, locate and predict the size of the presacral or anal peripheral tumor in terms of diagnosis.

…