Transrectal Endoscopic Resection of a Presacral Mass in a Teenage Girl

Abstract

Introduction:

Transanal microsurgery has revolutionized the care of adult patients with low stage rectal cancers and other benign masses of the distal colon. ^{1 –4} Few cases have been reported in the pediatric literature. ⁵ This video demonstrates a transrectal, endoscopic removal of an asymptomatic 3 cm cystic presacral mass discovered incidentally in a 14-year-old girl. A preoperative magnetic resonance imaging scan suggested the mass to be benign and showed no connection to the spinal canal. This is the first published report of such an excision.

Materials and Methods:

After receiving a mechanical bowel preparation, and oral and intravenous preoperative antibiotics, the patient was positioned in lithotomy. A multiport endoscopic device was placed in the anal verge. After CO₂ insufflation to 15 mm Hg, the rectum was incised at the distal extent of the mass and resected from the presacral space using a combination of blunt, sharp, and electrocautery dissection. The rectum was repaired transanally using full thickness, interrupted absorbable sutures.

Results and Conclusions:

The patient was discharged on postoperative day 1 and returned to full activity by postoperative day 4. Pathology analysis revealed an epidermoid cyst without atypical features. At 2-month follow-up, the patient remained asymptomatic. Transanal endoscopic surgery for removal of small presacral masses in the pediatric population offers a novel approach with the potential for low morbidity and rapid recovery.

No competing financial interests exist.

Runtime of video: 3 mins 58 secs