CASE REPORT   

Chirurgia 2019 October;32(5):280-3

DOI: 10.23736/S0394-9508.18.04915-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

A large size complicated epidermal cyst of perineum and gluteal region, with a long fistulous tract to the coccygeal area. A rare entity, challenging in diagnosis and surgical treatment

Anestis A. CHARALAMPOPOULOS ¹ ✉, Kostantinos G. KOPANAKIS ², Vasileios C. KOLLARAS ¹, Dimitrios C. PAPAKONSTANTINOU ¹, Nikolaos N. KOLIAKOS ¹, Frederick A. FARRUGIA ¹, Nikolaos I. ZAVRAS ¹

¹ Athens Medical School, Third Surgical Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece; ² Unit of Surgery, Thebes General Hospital, Thebes, Greece

Epidermal cysts of perineum are rare entities of obscure etio-pathogenesis, rarely found as cases reports in literature. A 36-year-old female, with a perineal epidermal cyst of the left ischiorectal space, long fistulous tract, and external opening in posterior retro-coccygeal area, is described. The past history, symptoms, imaging data, surgical intervention and results are registered. 1.5 years before admission, she was treated elsewhere for intermittent low-moderate fever up to 38.5˚Ϲ and draining an abscess of the retro-coccygeal area, due to inflamed cyst according to CT scan. The pathology report of the abscess wall revealed an epidermal cyst. Next year, in the surgical site of the drain, intermittent exit of a mucous content was observed. Before final surgery, an MRI of pelvis and ano-rectal canal, with fistula protocol was performed; showing a multi-loculated perineal cyst, at 6,4x3cm, and a long fistulous tract of 9 cm. Fistulectomy and circumferential excision of the cyst was performed. Cultures from cyst content showed enterococcus feacalis. Epidermal cysts of perineum are rare entities, even more inflamed cysts with fistula formation, rarely are mentioned in literature. Complicated cysts rise severe difficulties in surgery that is the only treatment in order to avoid severe perineal sepsis. Surgery of inflamed perineal epidermal cysts is quiet difficult. A meticulous analysis and study of imaging data and the changes in anatomy of perineum is compulsory and determine the success or fail of the surgical treatment.

KEY WORDS: Epidermal cyst; Perineum; Tomography, X-ray computed; Magnetic resonance imaging