Presacral schwannoma treated as irritable bowel syndrome

Abstract

Presacral tumours represent a heterogeneous group of predominantly benign and occasionally malignant neoplasms. These tumours, though rare, frequently present either incidentally or with vague symptoms. Schwannomas of the presacral region are one variant described as benign tumours of neurogenic origin. The case of a large presacral schwannoma in a 26-year-old man, who was treated for irritable bowel syndrome for 4 years, is presented. The patient presented with intermittent constipation, a feeling of incomplete evacuation of the bowel and vague abdominal discomfort relieved by defecation. The symptomatology worsened and constipation became frequent, and the patient experienced increased urinary frequency. Baseline investigations were normal and ultrasonography of the abdomen revealed a pelvic mass, which on CT scanning was revealed to be a large retrorectal mass. The tumour was resected and histology revealed it to be a schwannoma. This unique case is presented to emphasise that irritable bowel syndrome must be a diagnosis of exclusion, especially if atypical symptoms are present.

Management approach and surgical strategies for retrorectal tumours: a systematic review

“…They have been seen incidentally during gynaecological surgery and staging in breast malignancy . When symptomatic they may present with pain in the pelvis, back or abdomen, constipation , large bowel obstruction , palpable rectal mass , recurrent pilonidal sinus , pelvic and perianal abscess formation, irritable bowel syndrome and abnormal gait . The clinical presentation is heterogeneous and retrorectal tumours often pose diagnostic difficulty as non‐specific chronic pain and suppuration are the commonest symptoms .…”

“…The clinical presentation is heterogeneous and retrorectal tumours often pose diagnostic difficulty as non‐specific chronic pain and suppuration are the commonest symptoms . There is usually a significant delay in diagnosis . The median age for presentation is 45 years, but congenital and developmental tumours occur in younger patients .…”

Presacral Schwannoma Mascquerading as a Uterine Leiomyoma

“…These tumors tend to be slow-growing and cause minimal or nonspecific symptoms; therefore, they may be of considerable size at the time of diagnosis. Presacral tumors, especially benign ones, are asymptomatic for a long time or produce minimal or nonspecific symptoms, such as vague abdominal pain, constipation, paradoxical diarrhea, rectal tenesmus, and sexual dysfunction [3,4]. Presacral schwannomas may mimic uterine myomas due to their proximity to the uterus and image density similar to muscle.…”

The Treatment Efficacy of Transparasacral Approach For Presacral Tumor: A Single Center Experience

“…However, as the tumor grows, local compression such as lower abdominal, pelvic, or sacral pain, constipation (20,21), and anal bulge (22) and infection may appear. The large presacral tumor can also lead to intestinal obstruction (23), irritable bowel syndrome (24), gait abnormality (25). If the tumor capsule ruptures, the out ow of the tumor contents can also lead to infection, such as recurrent pilonidal hairs (26), pelvic abscesses (27), and perianal abscesses (28).…”