Bi-lobed perirectal epidermoid cyst: An unusual cause of hematochezia in a middle-aged woman

Abstract

Perirectal epidermoid cysts are congenital cysts originating from the ectodermal germ cell layer of the hind gut. Their presenting symptoms are most often nonspecific and distinguishing them from other presacral developmental cysts often present a diagnostic and therapeutic dilemma. We present a 58-year-old woman who presented with chronic dyschezia and hematochezia of a few days duration and no prior colonoscopies. Initial blood work and tumor markers were unremarkable. Pelvic magnetic resonance imaging (MRI) showed a 7.5 cm × 5 cm × 6 cm homogenous bi-lobed cystic mass in the pelvis adherent to the left lateral wall of the rectum and posteriorly to the sacrum with a displacement of the rectum anteriorly and to the right. There was no pelvic sidewall adenopathy or free fluid in the pelvis. Preoperative colonoscopy showed rectal compression with no rectal involvement of the mass. The cyst was successfully resected posteriorly via the trans-sacrococcygeal approach. An intraoperative proctosigmoidoscopy confirmed an intact rectum. The patient remains recurrence-free 1 year postsurgical resection.

Laparoscopic management of epidermoid cyst in an unusual location

“…Most often, the symptoms such as chronic abdominal pain, perianal discomfort, altered bowel habits, tenesmus and sacrococcygeal lump are non-specific. In case of infection, these masses may present with perianal discharge and fistulous opening 5 9. Though rare, but carcinomatous degeneration in these cysts has also been reported 8.…”

“…The pararectal spaces are paired, potential triangular spaces in the posterior pelvis. This potential space lies in between rectum and sacrum and is bounded by peritoneal reflection superiorly and levator muscles inferiorly 5. The epidermoid cyst in this location is a rare occurrence, with a reported incidence of 1 in 40 000 to 63 000 hospital admissions 6.…”

“…It involves the face, neck, upper back and trunk commonly. However, it is known to occur in unusual locations such as breast, liver, oral cavity, presacral region, etc 2–4. The pararectal spaces are paired, potential triangular spaces in the posterior pelvis.…”

Pararectal Epidermal Inclusion Cyst in a Pediatric Patient

“…For tumors below the mid-body of S3, posterior resection may be used. Other alternatives include a variety of procedures, such as trans-sacral or para-sacrococcygeal, posterior sagittal, intersphincteric, transsphincteric, or transsacrococcygeal approaches [ 12 ].…”

Perirectal epidermoid cyst in a patient with sacrococcygeal scoliosis and anal sinus: A case report

“…The presacral space is a triangular space between the posterior sacrum and anterior rectum that is bounded by the peritoneal reflection superiorly and levator ani muscles inferiorly[ 4 ]. Developmental cystic masses arising from the presacral space include several kinds of tumors including dermoid cysts, epidermoid cysts, chordomas, adrenal rest tumors, anterior sacral meningoceles, cystic hamartomas, tailgut and rectal duplication cysts[ 5 ].…”