Posterior surgical approach for excision of retrorectal epidermal inclusion cyst, a road less travelled by surgeon: case report

Retrorectal epidermal inclusion cysts are rare congenital cystic lesions, mostly an incidental finding usually diagnosed in middle-aged women. Surgical resection is the main stay of treatment and 3 operative approaches commonly used: abdominal, trans-sacral/coccygeal (posterior), combined abdomino-posterior depending on nature location lesion. We report a case 22-year-old male presented with complaints on-off constipation since 4 years, perineal heaviness 2 years. Based digital rectal exam, trans-rectal ultrasound, computed tomography, magnetic resonance imaging findings, presumptive diagnosis retrorectal cyst was made. Patient underwent excision lesion by posterior trans-coccygeal approach. Post histopathology confirmed cyst. On follow-up after one month, symptoms completely resolved. Posterior allows proximal extension for elimination infection cases adherence to surrounding structures or malignancy, which require en bloc resection. approach preferred patients presacral because it provides adequate exposure minimum dissection.