ABSTRACT

Presacral epidermoid cysts are rare lesions that become clinicaHy evident only when complicated by pain or infection. Usually they are asymptomatic and diagnosis is unexpected at the time of a gynaecological or ano-rectal examination or as an incidental finding report on a radiological examination such as a pelvic CT scan or MRI performed for other reasons. We report the case of a young male presenting with a perineal fistula. Clinical examination, pelvic MRI and CT scan demonstrated a infected pre-sacral cyst with a anal fistulous tract. Difficulty in localising the cyst, proximity to sacral promontory, the need to preserve the integrity of both the rectal wall and the hypogastric nerves from surgical injury led to adoption of a combined laparoscopic and perineal procedure for its complete excision.