Injuries that affect the presacral space are rare, and are part of a heterogeneous group of entities of primary concern to colorectal surgeons. These lesions are located in anatomically difficult area to be addressed, hence the need for prior surgical planning, as well as knowledge of the major diseases that affect this region.
The incidence of these lesions varies from 1: 40.000 to 1: 630,0007, being more common in females between 40 and 60 years8.
Man of 94 years showed changes in bowel habits few months ago. Digital rectal examination showed solid pelvic mass with no apparent invasion of the rectal mucosa; it is not possible to predict its upper limit. Computed tomography of the pelvis showed solid-cystic lesion in proximity to the sacrum bone and rectum, with apparent cleavage plane between adjacent structures (Figure 1). He underwent transperitoneal resection of the lesion. Major bleeding occurred during surgery, which was controlled, requiring blood transfusion with four blood cell concentrate units.
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