V86 - Surgical Excision of a Retrorectal Cyst: Case Presentation and Technique

Saturday, May 9, 2026

On-Demand

Video Presentation(s)

Ashley Toussaint, DO

Surgery Resident
RWJUH
RWJUH
Somerset, NJ, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Author(s)

Andrew Hu, MD

General Surgery Resident
UMass Chan Medical School
University of Massachusetts T.H Chan Medical School
Worcester, MA, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
NM

Nell Maloney Patel, MD

Professor of Surgery; Vice Chair of Education
Rutgers Robert Wood Johnson Medical School
Westfield, New Jersey, United States

Disclosure information not submitted.
Daniel L. Feingold, MD, FACS, FASCRS

Professor of Surgery
Rutgers University
New Brunswick, New Jersey, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
Kristen Donohue, MD, FACS, FASCRS

Assistant Professor of Surgery
Rutgers Robert Wood Johnson Medical School
Atlantic Highlands, New Jersey, United States

Disclosure information not submitted.

Senior Author(s)

BS

Brendan Scully, Md

Assistant professor
Rutgers Robert Wood Johnson
New Brunswick, New Jersey, United States

Disclosure information not submitted.

CME Eligible

Purpose/Background: Retrorectal cysts are rare cystic lesions located between the rectum and sacrum. Most retrorectal cysts are congenital and arise from embryological remnants, particularly from the tailgut, the most caudal part of the embryonic hindgut. Surgical excision is the treatment of choice to establish diagnosis and prevent complications, including potential malignant degeneration. We present a case of the open retrorectal cyst removal in a symptomatic patient, highlighting the techniques and outcomes.

Methods/Interventions: 65 yo F with no PMHx with a few months of perineal pain and burning unresponsive to estrogen and nystatin cream. Pt had a CT scan with IV contrast that did not have any pertinent findings prompting and MRI which identified a 4cm complex retrorectal cystic lesion consistent with developmental tailgut cyst. The pt presented to our office with sciatic pain and rectal burning. We proceeded with operative removal given potential for malignant transformation and presenting symptoms without pre-operative biopsy. The multicystic mass was removed through a parasacral incision. The mass was adherent to the posterior wall of the rectum and after removal of the mass the rectal wall was thin. This was buttressed with interrupted lembert sutures. After repair the rectum was inspected and without leak or narrowing. The incision was closed in several layers over a drain.

Results/Outcomes: The patient recovered well postoperative and noted resolution of her anal burning and sciatic pain. Pathology was consistent with cystic hamartoma, no malignancy or dysplasia seen.

Conclusion/Discussion: This case highlights the importance of recognizing retrorectal cysts as a potential source of unexplained pelvic or perineal pain and the posterior approach to excision. Complete surgical excision remains the definitive diagnostic and therapeutic approach, both to alleviate symptoms and to rule out malignancy. Careful operative planning and meticulous dissection are essential to avoid injury to adjacent structures and achieve excellent functional outcomes.