Presacral Dermoid Cyst in a Young Female: Diagnostic Evaluation and Surgical Approach Selection

Abstract

Background: Presacral or retro rectal dermoid cysts are rare congenital lesions arising from ectodermal remnants during embryogenesis. Due to their deep pelvic location and nonspecific symptoms, these lesions often pose diagnostic and surgical challenges. Case Presentation: We present a 21-year-old female with persistent lower back pain and constipation. MRI was done as Magnetic Resonance Imaging (MRI) is highly effective in visualizing pelvic anatomy, offering precise delineation of anatomical relationships and potential local invasion. Imaging revealed a large lobulated cystic lesion in the presacral region. The patient underwent complete surgical excision via an anterior transabdominal approach. Histopathology confirmed a dermoid cyst. Postoperative recovery was uneventful. Conclusion: Presacral dermoid cysts, though rare, should be considered in young adults with persistent pelvic symptoms. MRI is essential for preoperative planning. Surgical excision is curative and prevents complications such as infection or malignant transformation. This case report describes the case, diagnostic modality and operative approaches with complications as these lesions often misdiagnosed.