84 - Freie Mitteilung
17. Mai 2019, 08:15 - 09:45, Bellavista 5, 6. OG
Transanal approach to tailgut cyst after laparoscopic failure – A case report
M. Sparn, R. Käppeli, S. Bischofberger, L. Marti, W. Brunner, Presenter: M. Sparn (St. Gallen/Rorschach)
Tailgut cysts are very rare and account for only 1 in 40000 admissions. Females are predominantly affected (3:1), mean age at diagnosis is 36 y. Tailgut cysts bear a risk of malignant transformation of about 10 % and should therefore be removed. To date, the posterior approach to masses of the presacral mesorectal space (Kraske Procedure) including resection of the coccyx is considered the gold standard. In larger tumours especially above S3 abdominal approach is recommended. Recently also a transanal approach is available and herein we present a case resected by transanal approach after laparoscopic failure.
A 47-year old female was referred to our colorectal unit with a history of a slowly growing mass of the retrorectal space first diagnosed with 3 cm in 2013. No evacuation disturbances or sexual function interference was reported. MRI imaging showed a large, protruding mass of the presacral space, complete obliteration of the mesorectal fascia, no pathologic lymph nodes. Close contact to the rectal wall with infiltration into the submucosa was suspected. Previous operations were two lower abdominal median laparotomies due to myomas and two laparoscopies, one for interenteric adhesions. The second laparoscopy was performed in February 2018 in order to resect the presacral tumour, which could not be visualized despite dissection of the mesorectum from a right dorsal approach. Cytopathology of the irrigation fluid showed no diagnostic result. We performed a combined laparoscopic mobilization and transanal resection of the 9 x 8 x 6 cm large cyst. Due to the extent of the tumour and its broad contact a resection of the dorsal rectal wall had to be performed. Closure of defect was obtained by direct suture.
After an uneventful postoperative course, the patient was dismissed on postoperative day seven. Patients continence was not decreased. Histological examination showed a cystic lesion covered with part keratotic part transitional epithelium. Typical for tailgut cysts, there were no serosa or muscle fibres.
Tailgut cysts are rare but not uncommon. Despite posterior approach as gold standard and abdominal approach for larger cysts, transanal exploration and resection offers a new approach with reduced need for laparotomy or presacral approach and coccygectomy.