Transsacral rectocele following combined neurinoma resection: A case report.

Scheuermann, Uwe; Bartsch, Fabian; Jansen-Winkeln, Boris; Lang, Hauke; Kneist, Werner

INTRODUCTION This report describes for the first time a case of a transsacral rectocele after combined abdominotranssacral tumour resection. Furthermore, we demonstrate a method for laparoscopic defect repair. PRESENTATION OF CASE A 44-year-old Caucasian female presented to our hospital with strange gurgling sounds and a painless subdermal swelling in her lower back after resection of a presacral neurinoma two years earlier. Magnetic resonance imaging (MRI) showed a huge rectocele through a sacral defect extending into the subcutaneous tissue. We performed a laparoscopic defect repair with the implantation of a self-fixating mesh graft. Five days after surgery, the patient was discharged in a good general condition. Five months after the operation, a follow-up MRI showed a good postoperative result with the correct position of the rectum. DISCUSSION The repair of transsacral prolapses with attachment of a mesh is complicated by the high rigidity of the pelvis and its surrounding structures. The key criteria in choosing the method of operative approach are the size and content of the prolapse. Huge sacral defects with bowel prolapses require a transabdominal approach to enable repositioning the bowel into the abdomen and excluding bowel injuries and inner hernias. CONCLUSION A laparoscopic approach provides a good intraoperative visibility for a safe retrorectal preparation and mesh graft repair of sacral defects.