Surgical management of a giant retrorectal ganglioneuroma via an open anterior approach: a case report

Introduction and importance: Retrorectal ganglioneuromas (GNs) are exceptionally rare, benign tumors originating from neural crest cells of the sympathetic nervous system. Their presacral location presents significant surgical challenges. Case presentation: This case report describes the successful open anterior resection of a giant retrorectal GN measuring 10.5 cm in craniocaudal length in a 50-year-old man presenting with chronic pelvic pain and dyschezia. Clinical discussion: Preoperative MRI suggested a retrorectal schwannoma as the most likely diagnosis, while postoperative pathology revealed the mass to be a ganglioneuroma, highlighting the difficulty in differentiating retrorectal neurogenic tumors based on imaging alone. The extensive adherence of the tumor to the sacrum and left internal iliac artery necessitated ligation of the artery and a piecemeal resection technique, requiring a multidisciplinary team involving colorectal, neurosurgical, and vascular surgery. Conclusion: Despite a successful outcome with transient postoperative claudication, this case underscores the surgical complexities of large GNs and emphasizes the need for further research into less invasive surgical approaches to minimize complications.