A rare case of benign retrorectal teratoma in an adult female: Diagnostic challenges and successful surgical management.

ABSTRACT

INTRODUCTION: Retrorectal tumors are rare growths with various types which are found in the space behind the rectum. They can be diverse and are often diagnosed through imaging and surgery. PRESENTATION A 31-year-old female patient came to the clinic with concerns about irregular periods and constipation, but no history of abdominal pain, pelvic pressure, or weight loss. She had a previous surgery to remove an ovarian teratoma when she was three months old. Physical exams and lab tests showed no significant findings, except for a pelvic ultrasound that revealed a normal right ovary with a small follicle and a missing left ovary due to prior surgery for a dermoid cyst. Another cyst, measuring 8.2 × 9.3 × 5.7 cm, was found behind the uterus, believed to be a presacral cyst possibly originating from elsewhere. Further investigation with a CT scan confirmed the presence of a large cyst near the rectum, leading to an open surgical procedure to remove it. The cyst, located deep behind the rectum and next to the levator ani muscle, contained a substance resembling cheese with hair, suggesting a benign dermoid cyst with granulation tissue. The surgery was successful, and the diagnosis was confirmed through histopathological analysis. DISCUSSION: Retrorectal teratomas are rare germ cell tumors that mainly affect children, often presenting with vague symptoms like constipation. Diagnosis involves imaging tests like ultrasound, CT scans, and MRI, with surgical removal being the primary treatment option. Recurrence rates are low with complete excision of benign tumors. CONCLUSION: Retrorectal or presacral teratomas are rare tumors with vague symptoms, making diagnosis difficult. They are often detected late and require radiological assessment for surgical planning. Treatment success hinges on a coordinated effort by skilled radiologists and surgeons specializing in pelvic and oncological care to ensure favorable outcomes with lower recurrence rates and risks.