Ischiorectal Mass Excision Using Ultrasound-Guided, Wire-Needle Localization

TL;DR

A novel surgical technique using ultrasound-guided wire localization was used to safely remove a rare ischiorectal mass near the anal sphincter.

Contribution

A multidisciplinary, image-guided approach was applied to excise a non-palpable ischiorectal mass, similar to techniques used in breast surgery.

Findings

Ultrasound-guided wire localization enabled precise dissection of a nuchal-type fibroma near the anal sphincter.

The patient had a successful excision with negative margins and is undergoing regular surveillance MRIs.

This approach demonstrates a safe and effective method for managing rare, difficult-to-access soft tissue masses.

Abstract

In this work, we describe an unusual presentation of a nuchal-type fibroma, presenting as a mass in the ischiorectal space in an adult male. Since this lesion was not palpable and was in close proximity to the anal sphincter complex, we describe a novel multidisciplinary approach using wire-needle localization with interventional radiology to allow for a directed dissection, similar to an approach used in breast partial mastectomy surgeries.

A 56-year-old male presented with an incidentally found 2.1 × 2.7 × 1.8 cm ischiorectal mass that abutted the anal sphincter complex. Interventional radiology performed an ultrasound-guided wire needle localization which allowed for a directed dissection down to the lesion. Pathology was consistent with nuchal-type fibroma with negative margins. The patient now undergoes surveillance with semi-annual MRIs.

This case report describes a novel application of a hybrid surgical approach utilizing intraoperative image-guided localization for the safe excision of a rare soft tissue mass in an atypical, difficult-to-access location.

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