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

Tarchouli, Mohamed; Zentar, Aziz; Ratbi, Moulay Brahim; Bensal, Abdelhak; Khmamouche, Mohamed Réda; Ali, Abdelmounaim Ait; Bourazza, Ahmed; Elfahssi, Mohammed; Sair, Khalid

doi:10.1186/s13104-015-1457-5

Cited by 6 publications

(12 citation statements)

References 13 publications

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“…These masses may be approached transabdominally, transperineally or through a combined approach [1,2]. For lesions entirely below the third or fourth sacral vertebral level, the transperineal approach is preferred [3][4][5]. We present a video of transperineal excision of a retrorectal cyst in a 26-year-old woman, focusing on key steps of the operation to facilitate excision and minimize morbidity.…”

Section: Dear Editormentioning

confidence: 99%

Transperineal excision of a retrorectal mass – a video vignette

Sridhar

Mittal

2020

Colorectal Disease

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Section: Dear Editormentioning

confidence: 99%

Transperineal excision of a retrorectal mass – a video vignette

Sridhar

Mittal

2020

Colorectal Disease

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“…If complete surgical excision is not possible with an acceptable safety margin, local recurrence is a possibility. Generally, the posterior approaches in the prone jackknife position (modified Kraske procedure) are commonly used for incision of the ischiorectal fossa and presacral tumors [ 11 , 13 – 16 ]. The details of approach are dictated by the location and the size of the mass and its relationship with adjacent structures.…”

Section: Case Presentationmentioning

confidence: 99%

“…This approach can allow entry into the presacral space, at the point proximally above the location of the tumor. Low-lying tumors (the upper limit of the lesion is below the level of S4) can be removed by the posterior approach [ 11 , 16 , 17 ]. For small lesions (less than 5 cm), the lower sacrum can be spared [ 11 , 15 , 16 ].…”

Section: Case Presentationmentioning

confidence: 99%

“…Low-lying tumors (the upper limit of the lesion is below the level of S4) can be removed by the posterior approach [ 11 , 16 , 17 ]. For small lesions (less than 5 cm), the lower sacrum can be spared [ 11 , 15 , 16 ]. If the superior border of the tumor can be palpated during the digital examination, the posterior approach should be successful [ 17 ].…”

Section: Case Presentationmentioning

confidence: 99%

“…If the superior border of the tumor can be palpated during the digital examination, the posterior approach should be successful [ 17 ]. The posterior approach provides good access to the caudal component, but the major drawbacks are the absence of control over pelvic vessels and the potential for injury to the lateral pelvic nerves [ 16 ]. An anterior transabdominal approach is recommended for large and high-lying tumors which extend superiorly through the levator muscles) [ 13 ].…”

Section: Case Presentationmentioning

confidence: 99%

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A rare solitary fibrous tumor in the ischiorectal fossa: a case report

et al. 2018

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BackgroundA solitary fibrous tumor (SFT) is a rare mesenchymal tumor that occurs mostly in pleural sites, and an SFT occurring in the ischiorectal fossa is extremely rare. Because of the rarity, there are few reports detailing an SFT in the ischiorectal fossa.Case presentationA pararectal tumor was incidentally found in a 42-year-old man during a routine medical examination. The patient had no symptoms and no previous medical history. In the physical examination, a smooth-margined and hard elastic mass was felt, and in a digital rectal examination, the rectal mucosa appeared normal. A computed tomography (CT) scan showed a 5-cm, well-defined, solid mass in the left ischiorectal fossa. Contrast-enhanced CT in the early phase showed intense heterogeneous enhancement that persisted during the delayed phase. T2-weighted images of magnetic resonance imaging yielded heterogeneous intermediate and low signal intensity. Intense arterial enhancement suggested a hypervascular nature, and persistent delayed enhancement and low signal bands on T2-weighted images suggested a fibrous component of the mass. An SFT was suspected. Most SFTs are benign but have malignant potential. Our patient did not hope for surgery if the tumor was benign; therefore, an ultrasound-guided transperineal core needle biopsy was performed to decide on a treatment strategy. Microscopic examination showed tumor cells appearing as spindle and fibroblast-like cells within a collagenous stroma. Immunohistochemistry identified CD34 and vimentin, supporting the diagnosis of an SFT. The patient consented to excision of the mass. He was placed in a prone jackknife position, and the tumor was removed transperineally using a posterior approach (modified Kraske procedure). The levator ani muscle, external sphincter muscles, and rectum were not involved and separated from the tumor. The tumor was successfully resected en bloc with no complications. Five uneventful days post surgery, the patient was discharged. There was no local recurrence during the year following surgery.ConclusionImaging findings reflect the tissue characterization such as hypervascularity and fibrous nature of SFTs. We have presented a rare case of an SFT in the ischiorectal fossa with useful imaging findings for diagnosis, treatment strategy, and successful surgical removal using a posterior approach.

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Solitary fibrous tumor within the mesorectum: literature review based on a case report of resection by transanal minimally invasive surgery (TAMIS)

Ströse,

Sparn,

Klein

et al. 2024

Int J Colorectal Dis

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Purpose Solitary fibrous tumors (SFT) are a rare entity of in majority benign neoplasms. Nevertheless, up to 20% of cases show a malignant tendency with local infiltration or metastasis. Commonly arising in the thoracic cavity, only few cases of SFT of the mesorectal tissue have been reported in the literature. Complete surgical resection, classically by posterior approach, is the treatment of choice. The purpose of this review is to demonstrate the safety and suitability of transanal minimally invasive surgery (TAMIS) as a surgical approach for the resection of benign pararectal solid tumors. Methods We report the case of a 52-year-old man who was diagnosed incidentally with SFT of the distal mesorectum. Resection by TAMIS was performed. Based on this case, we describe the steps and potential benefits of this procedure and provide a comprehensive review of the literature. Results Histopathology confirms the completely resected SFT. After uneventful postoperative course and discharge on day four, follow-up was recommended by a multidisciplinary board by clinical examination and MRI, which showed a well-healed scar and no recurrence up to 3 years after resection. Conclusion SFT of the mesorectum is a very rare entity. To our knowledge, this is the first report on a TAMIS resection for SFT, demonstrated as a safe approach for complete resection of benign pararectal solid tumors.

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

Cited by 6 publications

References 13 publications

Transperineal excision of a retrorectal mass – a video vignette

Transperineal excision of a retrorectal mass – a video vignette

A rare solitary fibrous tumor in the ischiorectal fossa: a case report

Solitary fibrous tumor within the mesorectum: literature review based on a case report of resection by transanal minimally invasive surgery (TAMIS)

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