Annals of Coloproctology

Case Report

Malignant disease, Rectal cancer

Laparoscopic Resection of a Huge Retrorectal Tumor: Han Deok Kwak, Jae Kyun Ju; Ann Coloproctol. 2020;36(1):54-57. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2018.07.31.1

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Retrorectal space tumors are rare, and so are frequently unrecognized, misdiagnosed, and mistreated. A 57-year-old man visited the outpatient clinic with the chief complaints of thin stool and lower pelvic heaviness. A smooth, round huge palpable mass on the right posterolateral rectal wall was detected and pelvic computed tomography showed a 7.8-cm cystic lesion in the right retrorectal space. Laparoscopic procedures were initiated with perirectal dissection for rectal mobilization. After fixation of the peritoneum and tying the rectum for intracorporeal traction, the rectum was mobilized to identify the cyst. The cyst was removed using an endo-bag, with completion of cyst dissection. The final pathologic diagnosis was a tailgut cyst, or retrorectal cystic hamartoma without evidence of malignancy. The patient was discharged without any complications. The patient had no dyschezia or problems with bowel function. Laparoscopic resection is a safe and feasible method for surgical treatment, even for bulky retrorectal tumors, with an early recovery period.

Citations

Citations to this article as recorded by

Tailgut Cyst—Gynecologist’s Pitfall: Literature Review and Case Report
Andrei Mihai Malutan, Viorela-Elena Suciu, Florin Laurentiu Ignat, Doru Diculescu, Razvan Ciortea, Emil-Claudiu Boțan, Carmen Elena Bucuri, Maria Patricia Roman, Ionel Nati, Cristina Ormindean, Dan Mihu
Diagnostics.2025; 15(1): 108. CrossRef
Intraoperative endoscopic ultrasound‐guided robotic retrorectal dermoid cyst excision—A video vignette
Piercarmine Panzera, Francesco Vittore, Francesco Paolo Prete, Giuseppe Massimiliano De Luca, Silvia Malerba, Nicola Tartaglia, Arianna Pontrelli, Enrico Fischetti, Angela Gurrado, Mario Testini
Colorectal Disease.2025;[Epub] CrossRef
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Rui Li, Zhiyuan Yu, Jiahu Ye, Xin Liu, Peiyu Li, Xudong Zhao
World Journal of Surgical Oncology.2024;[Epub] CrossRef
Total Laparoscopic Excision of a Large Tailgut Cyst
Ajay Nimbalkar, Anand Zingade, Balaji Dhaigude
Cureus.2024;[Epub] CrossRef
Epidemiology, diagnostic approach and therapeutic management of tailgut cysts: A systematic review
Aikaterini Mastoraki, Ilias Giannakodimos, Karmia Panagiotou, Maximos Frountzas, Dimosthenis Chrysikos, Stylianos Kykalos, Georgios E. Theodoropoulos, Dimitrios Schizas
International Journal of Clinical Practice.2021;[Epub] CrossRef
Robotic approach to large tailgut cyst with malignant transformation: A case report
Alessandra Marano, Maria Carmela Giuffrida, Chiara Peluso, Valentina Testa, Paolo Bosio, Felice Borghi
International Journal of Surgery Case Reports.2020; 77: S57. CrossRef

Original Articles

Single-center Experience of 24 Cases of Tailgut Cyst: Ahmad Sakr, Ho Seung Kim, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim; Ann Coloproctol. 2019;35(5):268-274. Published online October 31, 2019; DOI: https://doi.org/10.3393/ac.2018.12.18

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289 Download
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47 Citations

Abstract PDF

Purpose
Tailgut cysts are rare congenital or developmental lesions that arise from vestiges of the embryological hindgut. They are usually present in the presacral space. We report our single-center experience with managing tailgut cysts.
Methods
We conducted a retrospective analysis of 24 patients with tailgut cyst treated surgically at the Colorectal Surgery Department of Severance Hospital, Yonsei University, Seoul, South Korea, between 2007–2018.
Results
This study included 24 patients (18 females) with a median age of 51.5 years (range, 21–68 years). Ten cases were symptomatic and 14 were asymptomatic. Cysts were retrorectal in 21 patients. Cysts were below the coccyx level in 16 patients, opposite the coccyx in 6, and above the coccyx in 2. Cysts were supralevator in 5 patients, had a supra- and infralevator extension in 18 patients, and were infralevator in 1. Ten patients were managed using an anterior laparoscopic approach, 11 using a posterior approach, and 3 using a combined approach. Mean cyst size was 5.5 ± 2.7 cm. Postoperative complications were Clavien-Dindo (CD) classification grade II in 9 patients (37.5%) and CD grade III in 1 (4.2%). The posterior approach group showed the highest rate of complications (P = 0.021). Patients managed using a combined approach showed a larger cyst size (P < 0.001), longer operation times (P < 0.001), and a greater likelihood of tumor level above the coccyx (P = 0.002) compared to other approaches. The tumors of 2 male patients were malignant: 1 was a neuroendocrine tumor treated with radiotherapy, while the other was a closely followed adenocarcinoma. Median follow-up was 12 months (range, 1–66 months) with no recurrence.
Conclusion
Tailgut cysts are uncommon but can cause perineal or pelvic pain. Complete surgical excision via an appropriate approach according to tumor size, location, and correlation with adjacent pelvic floor muscles is the key treatment.

Citations

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Clinical Study and Review of Articles (Korean) about Retrorectal Developmental Cysts in Adults: Sung Wook Baek, Haeng Ji Kang, Ji Yong Yoon, Do Youn Whang, Duk Hoon Park, Seo Gue Yoon, Hyun Sik Kim, Jong Kyun Lee, Jung Dal Lee, Kwang Yun Kim; J Korean Soc Coloproctol. 2011;27(6):303-314. Published online December 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.6.303

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21 Citations

Abstract PDF

Purpose

A retrorectal developmental cyst (tailgut cyst, epidermoid cyst, dermoid cyst, teratoma, and duplication) is very rare disease, and the symptoms are not characteristic so that sometimes this disease is still misdiagnosed as a supralevator abscess or a complex anal fistula. We would like to present a clinical approach to this disease.

Methods

We retrospectively examined the charts of 15 patients who were treated for retrorectal cysts from January 2001 to November 2009.

Results

All 15 patients were female. The average age was 41 years (range, 21 to 60 years). Fourteen patients (93.3%) were symptomatic, and the most common symptom was anal pain or discomfort. Nine patients (60%) had more than one previous operation (range, 1 to 9 times) for a supralevator abscess, an anal fistula, etc. In 12 patients (80%), the diagnosis could be made by using the medical history and physical examination. Thirteen cysts (80%) were excised completely through the posterior approach. The average diameter of the cysts was 4.8 cm (range, 2 to 10 cm). Pathologic diagnoses were 8 tailgut cysts (53.3%), 5 epidermoid cysts (33.3%) and 2 dermoid cysts (13.3%). The average follow-up period was 18.3 months (range, 1 to 64 months).

Conclusion

In our experience, high suspicion and physical examination are the most important diagnostic methods. If a female patient has a history of multiple perianal operations, a retrorectal bulging soft mass, a posterior anal dimple, and no conventional creamy foul odorous pus in drainage, the possibility of a retrorectal developmental cyst must be considered.

Citations

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International Journal of Surgery Case Reports.2023; 103: 107880. CrossRef
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Epidemiology, diagnostic approach and therapeutic management of tailgut cysts: A systematic review
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Case Reports

Carcinoid Tumor Arising within a Tailgut Cyst: A Case Report.: Lee, Chul Min , Lee, Seung Hyun , Jeon, Chang Wan , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2007;23(1):65-67.; DOI: https://doi.org/10.3393/jksc.2007.23.1.65

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9 Citations

Abstract PDF

Tailgut cysts are rare congenital lesions. They are believed to develop from remnants of the embryonic hindgut. Malignancy in tailgut cyst is extremely unusual. We experienced a case of a carcinoid tumor arising within a tailgut cyst at the presacral space. A 40-year-old woman was admitted for acute anal pain. Digital rectal examination revealed a 2-cm-sized submucosal tumor in the posterior midline rectum 4 cm above the anal verge. On sigmoidoscopic examination, the overlying rectal mucosa seemed to be intact. We performed a transanal incisional biopsy. The pathological diagnosis of the tumor biopsy revealed a malignant neuroendocrine tumor. The patient underwent an abdominoperineal resection. The tumor proved to be mutilocular cysts with a solid component. The cysts were diagnosed as tailgut cysts that were lined by a variety of epithelial types, including inner columnar cells, outer cuboidal cells, and transitional cells. The solid component in the cysts was confirmed as a carcinoid tumor on microscopic examination. Six months after the operation, she was found to have liver and brain metastases.

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Sung Wook Baek, Haeng Ji Kang, Ji Yong Yoon, Do Youn Whang, Duk Hoon Park, Seo Gue Yoon, Hyun Sik Kim, Jong Kyun Lee, Jung Dal Lee, Kwang Yun Kim
Journal of the Korean Society of Coloproctology.2011; 27(6): 303. CrossRef
Ghrelin-Producing Well-Differentiated Neuroendocrine Tumor (Carcinoid) of Tailgut Cyst. Morphological, Immunohistochemical, Ultrastructural, and RT-PCR Study of a Case and Review of the Literature
Stefano La Rosa, Luigi Boni, Giovanna Finzi, Davide Vigetti, Nikolaos Papanikolaou, Silvia Maria Tenconi, Gianlorenzo Dionigi, Moira Clerici, Silvana Garancini, Carlo Capella
Endocrine Pathology.2010; 21(3): 190. CrossRef

A Case of a Tailgut Cyst.: Kim, Sin Sun , Kim, Ji Yeon , Lee, Hye Kyung , Hwangbo, Seal , Kim, Jeong Gu , Lee, Dong Ho , You, Young Kyoung , Ahn, Chang Joon; J Korean Soc Coloproctol. 2005;21(2):105-108.

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Abstract PDF: The tailgut is a blind extension of the hindgut into the tail fold just distal to the cloacal membrane. Remnants of this structure may form a tailgut cyst. This is prone to infection and chronic fistula formation and has a long-term risk of malignancy. Non-recognition and incomplete treatment leads to morbidity. A twenty one year-old female patient visited our hospital with repeated perianal pain and discharge. Preoperative abdominopelvic MRI and endorectal ultrasonography revealed a retrorectal cyst suggestive of a tailgut cyst. She underwent a complete excision of the retrorectal mass through a presacral approach. She recovered uneventfully. This report includes the case and a brief review of tailgut cysts.

Two Cases of Tailgut Cyst.: Lee, Hun , Oh, Jae Hwan , Cho, Seung Yeon , Yang, Dal Mo , Ha, Seung Yeon; J Korean Soc Coloproctol. 2001;17(4):209-212.

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Abstract PDF: Tailgut cysts in retrorectal or presacral space are rare and the derivatives of the embryonic post-anal gut. It is thought to arise from vestiges of embryonic hindgut. The lesions were usually multicystic and lined by a variety of epithelial types, including ciliated columnar, mucin-secreting columnar, transitional, and squamous epithelium. Tailgut cyst has been found in men and women of various ages but is more common in women and is usually associated with middle age. They may be the source of the chronic perirectal symptoms and rarely undergo malignant change, so early diagnosis and accurate evaluation is important. Complete surgical resection should be considered because of a long term risk of malignant change. We report two cases of tailgut cyst.

Tailgut Cyst A case report.: Ahn, Byeong Yul , Jeong, Choon Sik , Lee, Dong Hee , Yu, Chang Sik , Lee, Ho Jung , Lee, Moon Kyu , Kim, Jin Cheon; J Korean Soc Coloproctol. 1998;14(3):617-620.

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Abstract PDF: Tailgut cyst is a rare congenital lesion in retrorectal space. The clinical significance of tailgut cyst presents its morbidity that occurs in the unrecognized and incompletely treated lesion. A forty four year-old female patient visited with lower abdominal pain during defecation. Preoperative abdominopelvic MRI and endorectal ultrasonography revealed a retrorectal mass suggestive of leiomyoma, dermoid cyst, teratoma, or duplication cyst of rectum. She underwent complete resection of retrorectal mass by transsphincteric approach. The mass was multilocular cyst lined by multiple types of epithelium. It was histologically confirmed as a tailgut cyst. She recovered uneventfully. This report includes the case and a brief review of tailgut cyst.

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