Retrorectal tumours are rare and comprise a wide range of etiologies such as congenital, inflammatory, neurogenic or osseous. Congenital etiologies are the most common.
Retrorectal tumours may be incidental and asymptomatic but they may present with pain in the pelvis, back or abdomen, constipation, large bowel obstruction, palpable rectal mass, recurrent pilonidal sinus, or pelvic and perianal abscess formation. among others. The clinical presentation is heterogeneous and retrorectal tumours often pose diagnostic difficulties as non-specific chronic pain and suppuration are the most common symptoms.
A 55-year-old woman with no former medical history came to the Outpatient Clinic complaining of lower back and lower right limb pain associated with hypoesthesia of the right gluteus.
A colonoscopy described an extrinsic compression of the cecum.
A MRI was performed in which a 6.4 x 7.8 x 6.2 cm bilobulated encapsulated presacral tumor was found. The tumor was in contact with the sacral foramina but had no signs of infiltration. (FIG1, FIG2).
A gastroscopy was attempted but the endoscopy were unable to retrieve the knife safely so
A laparoscopic approach was performed with 5 ports (12mm: umbilical and right lower quadrant; 5 mm: left and right flanks and epigastrium). A neuromapping of the sacral nerves was performed in order to preserve them during the resection. A large tumour was found and a full resection was performed.
The postoperative evolution was uneventful. The final Pathology report reported myelolipoma.