Aggressive resection at the level of the low rectum requires extensive surgical dissection of the retrorectal space
, with the potential for inadvertent injury to surrounding neurovascular structures, such as the pelvic splanchnic nerves and superior and inferior hypogastric plexus.
Congenital or acquired lesions of the retrorectal space
, also called the presacral space, represent a rare type of tumors.
The retrorectal space
is between the rectum and the sacral-coccygeal part of spine.
(8,9) Retrorectal tailgut cysts, also known as retrorectal cystic hamartomas, are rare congenital lesions in the retrorectal space
. (10) These embryogenic cell-derived cysts can be classified as epidermoid cysts, dermoid cysts, neurogenic cysts, teratomas, and enteric cysts.
Khatri, "Tumors of the retrorectal space
," Diseases of the Colon and Rectum, vol.
However, one of the them was treated as perianal abscess with no preoperative imaging  and another one had a cyst centered in the retrorectal space
with extension into the perineal and gluteal areas .
At first, the retroperitoneum was dissected at the sacral promontory to enter the left Toldt's space and retrorectal space
from the right side of the sigmoid mesocolon.
On CT, these lesions are typically well-marginated, thin-walled, uni- or multilocular, nonenhancing lesions in the retrorectal space
. Rare cases of associated thin calcifications have been reported.
Retrorectal neoplasms refer to a rare and heterogeneous group of tumors that occur in what is known anatomically as the retrorectal space
. This is a potential space defined superiorly by the rectal peritoneal reflection, anteriorly by the rectum, posteriorly by the sacrum, and inferiorly by the rectosacral fascia.
It is important to exclude these lesions before sorting through the spectrum of congenital, inflammatory, neurogenic or osseous tumours that occur in the retrorectal space
. Teratomas, epidermoid and dermoid cysts, rectal duplication cysts and anal cysts may share similar characteristics with a tailgut cyst.
Retrorectal cyst hamartoma (RCH), also commonly known as tailgut cyst, is a rare benign cystic lesion located in the retrorectal space
and is believed to derive from persistence of embryologic remnants of the post anal gut (tailgut), which appears at the 3.5-mm stage of the human embryo.
[TIP] In a case in which the promontory is difficult to find, dissecting the retrorectal space
is a simple way to mobilize the bowel away from the sacrum, thus exposing the promontory.