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CASE REPORT
Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 177-178
 

Presacral dermoid cyst presenting as acute retention of urine


Department of Urology, Cosmopolitan Hospital, Trivandrum, India

Correspondence Address:
Joy Jyothis
Department of Urology, Cosmopolitan Hospital, Trivandrum - 695 004
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Presacral dermoid, retrorectal tumours, acute retention of urine


How to cite this article:
Stephen J, Haridas T V, Thomas P A, Ramachandran S, Jyothis J. Presacral dermoid cyst presenting as acute retention of urine. Indian J Urol 2004;20:177-8

How to cite this URL:
Stephen J, Haridas T V, Thomas P A, Ramachandran S, Jyothis J. Presacral dermoid cyst presenting as acute retention of urine. Indian J Urol [serial online] 2004 [cited 2019 Aug 23];20:177-8. Available from: http://www.indianjurol.com/text.asp?2004/20/2/177/20756



   Case Report Top


A 56-year-old male presented with a history of diffi­culty in passing urine to a local hospital. He was diag­nosed to have benign prostatic hypertrophy and was started on alpha blockers. His symptoms gradually increased and 15 days later he presented to our hospital with acute re­tention of urine. Per rectal examination showed a mass behind the rectum. Abdominal examination showed a mass arising from the pelvis. He was catheterized. Routine bio­chemical examination was normal. Abdominal ultrasound showed a well defined heterogenous mass on the left lat­eral pelvic wall. Intravenous urogram (IVU) showed left­sided hydroureteronephrosis. Cystoscopy showed an extravesical growth compressing the bladder neck and trig­one. Computed tomography (CT) scan the abdomen showed a large well-defined solid mass of mixed density in the presacral region measuring 122 x 92 x 86 mm extenting up to the retrovesical area towards the left side [Figure - 1]. Per rectal core needle biopsy was done which yielded cheesy material with hair in the specimen. His­topathology report was dermoid cyst. Exploratory laparo­tomy was done. The tumour was found occupying the presacral hollow on the left side, pushing the rectum to the right side, with no signs of infiltration into the rectum or sacrum. The tumour wall was very thin and was broken in the process of removal. The rectal wall and sacrum were normal. The abdomen was closed after peritoneal lavage. Postoperatively urinary catheter was kept for one week, and after removal, patient voided normally. Histopathol­ogy report was consistent with dermoid cyst.


   Comments Top


The retrorectal space is an area where the neuroecto­derm, the notochord, the hindgut and the proctodeum un­dergo remodeling and regression in embryological life. It can thus be the site of a heterogeneous group of benign and malignant tumours originating from vesical tissue derived from the three germinal layers.

Retrorectal tumours are rare. Most publications describe only individual cases. Retrorectal tumours are usually classified as congenital, inflammatory, neurogenic, os­seous, or miscellaneous. [1] More than 50% of these lesions are congenital. Developmental cysts constitute the ma­jority of the congenital lesions and may arise from any of the germ cell layers. [2] Developmental cysts often contain columnar or transitional epithelium (tailgut cysts or mu­cus-secreting cysts) of squamous epithelium with (presac­ral dermoid) or without (epidermoid) skin appendages. [1] More common in females, developmental cysts are often diagnosed in the fourth and fifth decade of life. They are often asymptomatic and are discovered incidentally dur­ing anal digital examination as a soft, compressible, ill­defined mass behind the rectum. [1],[2] Some patients complain of pain, particularly when sitting. Other complaints in­clude constipation, urinary symptoms, recurrent infection, or obstructed labour. [2] Developmental cysts can become infected and be confused with a supralevator abscess or a fistula-in-ano. [1],[2] The diagnosis is often confirmed by CT scan, magnetic resonance imaging or endorectal ultra­sound. Other diagnostic tests (e.g. barium enema, sia­moidoscopy, intravenous pyelogram) may be used selectively. Surgical resection is the treatment of choice, even in asymptomatic patients. Removing them will help confirm the diagnosis, exclude malignancy and prevent infection. [1],[3]

 
   References Top

1.Uhlig BE, Johnson RL. Presacral tumours and cysts in adults. Dis Col Rectum 1975: 18: 581-9.  Back to cited text no. 1    
2.Kodner IJ. Rectan cancer. In: Zinner MJ, Schwartz SI, Ellis H (edi­tors). Maingot's Abdominal Operations, 10 th ed. Appleton & Lange, A Simson and Schuster Company, 1997: pp 1494-5.  Back to cited text no. 2    
3.Stewart RJ, Humpreys WG, Park TG. The presentation and man­agement of presacral tumours. Br J Surg 1986; 73: 153-5.  Back to cited text no. 3    


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