Soltany Setareh
Cancer Research Center, Department of Surgery, Semnan University of Medical Sciences, Semnan, IR Iran.
Iran Red Crescent Med J. 2016 Jul 24;18(9):e31439. doi: 10.5812/ircmj.31439. eCollection 2016 Sep.
Retrorectal cysts are rare benign lesions which are frequently diagnosed in middle-aged females. According to their origin and histopathologic features, retrorectal cysts are classified as squamous-lined (dermoid or epidermoid) cysts, postanal gut (tailgut) cysts, and rectal duplications (enteric or enterogenous cysts, enterocystomas). Described in this case report is an extremely unusual patient, a woman who simultaneously had a retrorectal cyst and an ovarian serous cystadenoma in addition to a long history of misdiagnosis and multiple unsuccessful surgeries.
The patient was a 45-year-old female who presented with back pain, rectal fullness, constipation, and urinary symptoms. Upon her first pregnancy, a cystic pelvic mass had been misdiagnosed as an ovarian cyst. During the following 17 years, she had undergone several ineffective operations. The last CT scan and MRI studies revealed two separate noncalcified, unilocular, cystic lesions with well-defined borders in the retrorectal and retroperitoneal spaces. Two cysts were excised completely by a combined abdominoperineal approach. Pathological assessment revealed a dermoid cyst and an ovarian serous cystadenoma. No complications occurred during the 18 months of follow-up.
Coexistence of a retrorectal cyst and a serous cystadenoma is very unusual. Retrorectal cysts are rare entities that remain a difficult diagnostic and therapeutic challenge. Misdiagnosis and multiple unsuccessful surgeries are common. Complete surgical removal is the treatment of choice and requires a multidisciplinary approach in complicated cases.
直肠后囊肿是罕见的良性病变，常在中年女性中被诊断出来。根据其起源和组织病理学特征，直肠后囊肿可分为鳞状内衬（皮样或表皮样）囊肿、肛后肠（尾肠）囊肿和直肠重复畸形（肠源性囊肿、肠囊肿瘤）。本病例报告描述了一位极其特殊的患者，一名女性，她同时患有直肠后囊肿和卵巢浆液性囊腺瘤，此外还有长期误诊和多次手术失败的病史。
患者为一名45岁女性，出现背痛、直肠胀满、便秘和泌尿系统症状。她首次怀孕时，盆腔囊性肿块被误诊为卵巢囊肿。在接下来的17年里，她接受了几次无效的手术。最后一次CT扫描和MRI检查显示，在直肠后和腹膜后间隙有两个边界清晰的独立的非钙化、单房囊性病变。通过联合腹会阴入路将两个囊肿完全切除。病理评估显示为皮样囊肿和卵巢浆液性囊腺瘤。随访18个月期间未发生并发症。
直肠后囊肿和浆液性囊腺瘤同时存在非常罕见。直肠后囊肿是罕见的实体，仍然是诊断和治疗上的难题。误诊和多次手术失败很常见。完整的手术切除是首选的治疗方法，在复杂病例中需要多学科方法。
