Surgical Excision of A Giant Presacral Epidermoid Cyst: A Case Report and Review of the Posterior Surgical Strategy

¹Fakhiri Nassima,¹Benzidane Kamal,^1*El Kabbaj Abderrahmane,¹Bouali Ichrak,¹Ettaoussi Abdelhak,¹Majd Abdessamad,¹Kamal Khadija,¹Bouali Mounir,¹Elbakouri Abdelillah,²Khaleq Khalid,¹El Hattabi Khalid

¹Department Of Visceral Surgery Emergency, CHU Ibn Rochd, Casablanca, Morocco, Hassan Ii University, Ain Chok
²Department Of Anesthesia And Resuscitation, CHU Ibn Rochd, Casablanca, Morocco, Hassan Ii University, Ain Chok

DOI: 10.58806/ijhmr.2026.v5i4n06

ABSTRACT

Retrorectal tumors are rare lesions arising in the potential space between the rectum and the sacrum. Their nonspecific clinical presentation frequently leads to misdiagnosis and inappropriate surgical management. Epidermoid cysts represent a significant subset of congenital retrorectal lesions, typically occurring in middle-aged women.
We report the case of a 32-year-old male presenting with a two-year history of a slowly progressive, painless gluteal mass. Physical examination revealed a fluctuating mass in the sacrococcygeal region. Magnetic Resonance Imaging (MRI) demonstrated an unilocular cystic lesion in the retrorectal space below the S3 vertebral level. The patient underwent complete en bloc excision via a posterior (Kraske) approach. Histopathological analysis confirmed a benign epidermoid cyst. The postoperative course was uneventful, with no evidence of recurrence during follow-up.
This case highlights the diagnostic importance of pelvic MRI in evaluating indeterminate perianal masses. Preoperative biopsy is contraindicated for cystic lesions due to the risk of infection. The posterior approach provides excellent exposure for low-lying tumors, allowing for complete resection while preserving pelvic floor function. A high index of suspicion is essential to avoid confusion with common anorectal conditions such as pilonidal disease.

KEYWORDS

Retrorectal tumor, Presacral cyst, Epidermoid cyst, Kraske procedure, Sacrococcygeal region

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Cite this article

Nassima, F., Kamal, B., Abderrahmane, E. K., Ichrak, B., Abdelhak, E., Abdessamad, M., Khadija, K., Mounir, B., Abdelillah, E., Khalid, K., & Khalid, E. H. (2026). Surgical Excision of A Giant Presacral Epidermoid Cyst: A Case Report and Review of the Posterior Surgical Strategy. INTERNATIONAL JOURNAL OF HEALTH & MEDICAL RESEARCH, 5(4), 314-319. https://doi.org/10.58806/ijhmr.2026.v5i4n06