A Longstanding Pre-coccygeal Cyst With Recurrent Infection and Fistulisation: A Rare Case of a Presacral Lesion in a Young Woman

TL;DR

A young woman had a rare presacral cyst that grew over five years, causing pain and infection, and was managed conservatively with monitoring.

Contribution

This case highlights the diagnostic challenges and management of a rare, longstanding presacral cyst in a young woman.

Findings

The cyst increased in size over five years, likely due to hormonal changes during pregnancies.

MRI and CT showed a complex, encapsulated lesion with no malignancy.

Conservative management was chosen due to the lack of malignancy and surgical risks.

Abstract

Presacral cystic lesions are rare and diagnostically challenging due to their nonspecific symptoms and deep anatomical location. We report a case of a young woman with a pre-coccygeal cyst, first identified following an emergency Caesarean section in 2020. Over the next five years, the lesion increased in size, likely exacerbated by hormonal changes during successive pregnancies, resulting in chronic pelvic pain, neurological symptoms, and cutaneous fistulisation.

Imaging via MRI and CT demonstrated a complex, encapsulated lesion with peripheral enhancement and restricted diffusion. Multidisciplinary evaluation suggested a congenital epidermoid or duplication cyst. Given the absence of malignancy and surgical complexity, a conservative management strategy was adopted.

This case underscores the importance of including longstanding presacral cysts in differential diagnoses and highlights the value of multidisciplinary input and long-term surveillance in guiding management.

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