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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

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Fig3: Operative view

Mentions: According to these findings, the patient was planned for surgical excision without a preoperative fine-needle biopsy. We chose a perineal approach under spinal anesthesia. The patient was placed in the lithotomy position. Through a vertical para-anal skin incision of about 10 cm centered on the lesion, the subcutaneous planes were divided and the retrorectal space was exposed. We discovered a soft tumor-mass, deeply extending into the ischiorectal fossa, and intimately adherent to the posterior face of the rectum and levator ani, but with a cleavage line making easy the tumor dissection from the surrounding tissue. The mass was carefully dissected (essentially blunt dissection) and completely excised, with special attention to avoiding injuries to the sphincter complex and rectal perforation (Figs. 3, 4). After tumor excision, the wound was closed in anatomical planes and drains left in the retro-rectal space for 48 h.Fig. 3


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)

Operative view
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Operative view
Mentions: According to these findings, the patient was planned for surgical excision without a preoperative fine-needle biopsy. We chose a perineal approach under spinal anesthesia. The patient was placed in the lithotomy position. Through a vertical para-anal skin incision of about 10 cm centered on the lesion, the subcutaneous planes were divided and the retrorectal space was exposed. We discovered a soft tumor-mass, deeply extending into the ischiorectal fossa, and intimately adherent to the posterior face of the rectum and levator ani, but with a cleavage line making easy the tumor dissection from the surrounding tissue. The mass was carefully dissected (essentially blunt dissection) and completely excised, with special attention to avoiding injuries to the sphincter complex and rectal perforation (Figs. 3, 4). After tumor excision, the wound was closed in anatomical planes and drains left in the retro-rectal space for 48 h.Fig. 3

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