Tailgut cyst, also known as retrorectal cystic hamartoma, is a rare congenital lesion arising from remnants of the post-anal gut and typically located in the retrorectal space 1, 2. It predominantly affects adult women and may remain asymptomatic until complicated by infection, hemorrhage, fistulization, or, more rarely, malignant transformation 1, 3. We report the case of a 49-year-old woman with no notable past medical history who presented with chronic proctologic symptoms. Digital rectal examination revealed extensive pararectal induration. Laboratory tests showed a white blood cell count of 10,000/mm3 and a C-reactive protein level of 9 mg/L, with no other remarkable abnormalities. Pelvic MRI demonstrated a multiloculated retro-anal cystic lesion extending into the retro-anal fat, showing heterogeneous signal intensity with fluid content, hemorrhagic foci hyperintense on T1-weighted imaging, and additional T2-hyperintense areas with diffusion restriction and peripheral enhancement, suggestive of abscessed changes with fistulization toward the vagina. CT-guided biopsy and drainage were performed using a 16G, 15 cm semi-automatic needle with a coaxial system. The patient was started on dual antibiotic therapy, and the first follow-up assessment was highly favorable. Additional surgical drainage was proposed. Histopathological results are pending. Overall, the clinicoradiologic presentation was primarily suggestive of a complicated tailgut cyst. This case highlights the key role of MRI in characterizing complicated retrorectal lesions and supports a multidisciplinary management strategy, while complete surgical excision remains the definitive treatment reported in the literature 1-4.
Achraf et al. (Sat,) studied this question.