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Perineal approach for surgical treatment in a patient with retro-rectal tumor: a case report and review of the literature.

Tarchouli M, Zentar A, Ratbi MB, Bensal A, Khmamouche MR, Ali AA, Bounaim A, Elfahssi M, Sair K - BMC Res Notes (2015)

Bottom Line: A suitable operative approach is the key to the successful surgical management.Although the large size of the mass (>7 cm in the greater diameter), it was successfully and completely excised through only perineal approach without undertaking coccygectomy or sacrectomy.The patient is currently in 4-years follow-up with no signs of recurrence or metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco. mtarchouli@gmail.com.

ABSTRACT

Background: Retrorectal tumors in adults are very rare and little known condition. These tumors, often misdiagnosed or mistreated, should be completely excised because of the potential for malignancy or infection. A suitable operative approach is the key to the successful surgical management.

Case presentation: We report the case of a 45-year-old Arab male who presented with chronic pelvic pain accompanied by straining to defecate and dysuria. The clinical examination showed a painless mass in the left perineal area. Pelvic magnetic resonance imaging and computed tomography scan demonstrated a huge and well-limited pelvic mass causing displacement and compression of the rectum and bladder. Although the large size of the mass (>7 cm in the greater diameter), it was successfully and completely excised through only perineal approach without undertaking coccygectomy or sacrectomy. The histopathological study revealed a low-grade leiomyosarcoma. The patient is currently in 4-years follow-up with no signs of recurrence or metastasis.

Conclusion: Even large retro-rectal tumors may be successfully excised by the perineal approach especially in carefully selected patients, but require extensive knowledge of pelvic anatomy and expertise in pelvic surgery.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan findings: axial section demonstrating a bulky and well-circumscribed mass developing in the pelvis with evident displacement of the rectum and bladder
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Fig1: Computed tomography scan findings: axial section demonstrating a bulky and well-circumscribed mass developing in the pelvis with evident displacement of the rectum and bladder

Mentions: Abdominal ultrasound detected a hypoechoic solid pelvic mass with regular contours and heterogeneous echostructure, but relationship with the surrounding structures was not clear. On computed tomography (CT) scan the lesion appeared as a large heterogeneous mass measuring approximately 7 cm in diameter. This mass, developed in the latero-rectal space, extended to the left side of the pelvis causing displacement and compression of the rectum and urinary bladder. There was no pelvic effusion, deep lymph nodes or bone destruction (Fig. 1). Additionally, pelvic magnetic resonance imaging (MRI) confirmed the presence of a 7 cm × 7 cm well-limited lesion in continuity with the left rectal wall and extending from the fourth sacral vertebra (S4) level to the coccygeal region. The lesion had low signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images without any signs of bladder invasion or any evident communication with the lumen of the rectum (Fig. 2). Moreover, rectoscopy detected a bulging mass with intact mucosa in the posterior wall of the rectum. Routine blood tests and serum tumor markers including carcinoembryonic antigen, cancer antigen 19–9, cancer antigen 125, prostatic specific antigen and α-fetoprotein were within normal range.Fig. 1


Perineal approach for surgical treatment in a patient with retro-rectal tumor: a case report and review of the literature.

Tarchouli M, Zentar A, Ratbi MB, Bensal A, Khmamouche MR, Ali AA, Bounaim A, Elfahssi M, Sair K - BMC Res Notes (2015)

Computed tomography scan findings: axial section demonstrating a bulky and well-circumscribed mass developing in the pelvis with evident displacement of the rectum and bladder
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4581409&req=5

Fig1: Computed tomography scan findings: axial section demonstrating a bulky and well-circumscribed mass developing in the pelvis with evident displacement of the rectum and bladder
Mentions: Abdominal ultrasound detected a hypoechoic solid pelvic mass with regular contours and heterogeneous echostructure, but relationship with the surrounding structures was not clear. On computed tomography (CT) scan the lesion appeared as a large heterogeneous mass measuring approximately 7 cm in diameter. This mass, developed in the latero-rectal space, extended to the left side of the pelvis causing displacement and compression of the rectum and urinary bladder. There was no pelvic effusion, deep lymph nodes or bone destruction (Fig. 1). Additionally, pelvic magnetic resonance imaging (MRI) confirmed the presence of a 7 cm × 7 cm well-limited lesion in continuity with the left rectal wall and extending from the fourth sacral vertebra (S4) level to the coccygeal region. The lesion had low signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images without any signs of bladder invasion or any evident communication with the lumen of the rectum (Fig. 2). Moreover, rectoscopy detected a bulging mass with intact mucosa in the posterior wall of the rectum. Routine blood tests and serum tumor markers including carcinoembryonic antigen, cancer antigen 19–9, cancer antigen 125, prostatic specific antigen and α-fetoprotein were within normal range.Fig. 1

Bottom Line: A suitable operative approach is the key to the successful surgical management.Although the large size of the mass (>7 cm in the greater diameter), it was successfully and completely excised through only perineal approach without undertaking coccygectomy or sacrectomy.The patient is currently in 4-years follow-up with no signs of recurrence or metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco. mtarchouli@gmail.com.

ABSTRACT

Background: Retrorectal tumors in adults are very rare and little known condition. These tumors, often misdiagnosed or mistreated, should be completely excised because of the potential for malignancy or infection. A suitable operative approach is the key to the successful surgical management.

Case presentation: We report the case of a 45-year-old Arab male who presented with chronic pelvic pain accompanied by straining to defecate and dysuria. The clinical examination showed a painless mass in the left perineal area. Pelvic magnetic resonance imaging and computed tomography scan demonstrated a huge and well-limited pelvic mass causing displacement and compression of the rectum and bladder. Although the large size of the mass (>7 cm in the greater diameter), it was successfully and completely excised through only perineal approach without undertaking coccygectomy or sacrectomy. The histopathological study revealed a low-grade leiomyosarcoma. The patient is currently in 4-years follow-up with no signs of recurrence or metastasis.

Conclusion: Even large retro-rectal tumors may be successfully excised by the perineal approach especially in carefully selected patients, but require extensive knowledge of pelvic anatomy and expertise in pelvic surgery.

No MeSH data available.


Related in: MedlinePlus