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Case Report Open Access

Presacral tailgut cyst with complex perianal fistula: A case report and a brief review of the literature

  • Authors:
    • Shaban Latif
    • Omer H. Ghalib
    • Salah M. Fateh
    • Sivan H. Salih
    • Rawa M. Ali
    • Karokh F. Hama Hussein
    • Kani A. Ahmad
    • Hiwa O. Abdullah
    • Meer M. Abdulkarim
    • Fahmi H. Kakamad

  • View Affiliations / Copyright

    Affiliations: Department of Breast Surgery, Smart Health Tower, Sulaymaniyah 46001, Iraq, Department of Gastrointestinal Surgery, Smart Health Tower, Sulaymaniyah 46001, Iraq, Department of Clinical Sciences, College of Medicine, University of Sulaimani, Sulaymaniyah 46001, Iraq, Department of Gastroenterology, Gastroenterology and Hepatology Teaching Hospital, Sulaymaniyah 46001, Iraq, Department of Pathology, Smart Health Tower, Sulaymaniyah 46001, Iraq, Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah 46001, Iraq
    Copyright: © Latif et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 32
    |
    Published online on: February 26, 2026
       https://doi.org/10.3892/wasj.2026.447
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Abstract

Tailgut cysts (TGCs) are rare congenital cystic lesions that pose diagnostic challenges due to varied manifestations, anatomic locations and a tendency to mimic or associate with other anorectal or pelvic pathologies. The present case report describes a challenging case of TGC associated with a complex perianal fistula. A 41‑year‑old female patient presented with painful defecation. A digital rectal examination revealed a deep, soft, ill‑defined fullness palpable in the presacral region. There were no palpable masses, secondary tracts, abscess cavities, or signs of purulent discharge. Magnetic resonance imaging revealed a multiloculated cystic lesion in the presacral region associated with a complex perianal fistula. The cyst and its associated fistulous tract were removed by en bloc excision. A histopathological examination of the cyst confirmed a TGC. In addition, in reviewing 13 recently reported cases, the common clinical presentations included lower abdominal or pelvic pain and constipation, while approximately a quarter of the cases were incidentally found. Malignant transformation was documented in 5 cases, most commonly into adenocarcinoma, with metastases in 3 cases. Of the cases with malignant transformation, 3 cases succumbed to disease. All patients underwent surgical excision, with the open approach used most frequently (~76.9%). Outcomes were excellent among patients with benign lesions, with no recurrence during follow‑up, whereas those with malignant transformation had a poorer prognosis. TGCs may be associated with or masked by other perianal conditions, such as fistulas, necessitating proper investigation to avoid misdiagnosis or improper management.
View Figures

Figure 1

(A) Axial section images [images on the upper panel (left panel, T2-weighted fat-saturated; right panel, T2-weighted); images on the lower panel (left panel, T1 fat-saturated pre-contrast; right panel, T1 fat-saturated post-contrast)] illustrating an elongated multiloculated thin-walled cystic lesion in the presacral space (green arrows), extending from the posterior aspect of the rectum toward the sacrococcygeal region while rectum and vertebrae are normal with no surrounding soft tissue edema. (B) Sagittal plane images (left panel, T2-weighted fat-saturated; middle panel, T2-weighted; right panel, T1 fat-saturated post-contrast) illustrating a presacral space lesion (green arrows), which is above the pelvic diaphragm and extending toward the anorectal junction.

Figure 2

(A) The lesion is cystic and contains numerous broad fibrous papillae that are lined by epithelium. There is debris in the lumen of the cyst. (B) There are various types of epithelium in the lining and wall of the cyst, including transitional, stratified squamous, mucinous columnar, and flat to low cuboidal epithelium. (C) The transitional epithelium is stratified and composed of tall cells with indistinct cytoplasmic borders, a moderate amount of lightly eosinophilic cytoplasm, and oval nuclei with fine chromatin. It differs from the transitional epithelium of the urothelial tract and does not belong to an otherwise specific category of epithelium in the body. (D) The stratified squamous epithelium is non-keratinizing and is composed of cells with distinct cytoplasmic borders, a moderate amount of clear to lightly eosinophilic cytoplasm, and round nuclei with fine chromatin. The mucinous glands are lined by tall columnar cells with abundant cytoplasmic mucin and small, round nuclei with fine chromatin. (E) The flat to low cuboidal epithelium lines some areas of the cyst and is composed of cells with minimal eosinophilic cytoplasm and oval nuclei with fine chromatin. Images illustrate hematoxylin and eosin staining; (A and B) original magnification, x40; (C-E) original magnification, x400.
View References

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Copy and paste a formatted citation
Spandidos Publications style
Latif S, Ghalib OH, Fateh SM, Salih SH, Ali RM, Hama Hussein KF, Ahmad KA, Abdullah HO, Abdulkarim MM, Kakamad FH, Kakamad FH, et al: Presacral tailgut cyst with complex perianal fistula: A case report and a brief review of the literature. World Acad Sci J 8: 32, 2026.
APA
Latif, S., Ghalib, O.H., Fateh, S.M., Salih, S.H., Ali, R.M., Hama Hussein, K.F. ... Kakamad, F.H. (2026). Presacral tailgut cyst with complex perianal fistula: A case report and a brief review of the literature. World Academy of Sciences Journal, 8, 32. https://doi.org/10.3892/wasj.2026.447
MLA
Latif, S., Ghalib, O. H., Fateh, S. M., Salih, S. H., Ali, R. M., Hama Hussein, K. F., Ahmad, K. A., Abdullah, H. O., Abdulkarim, M. M., Kakamad, F. H."Presacral tailgut cyst with complex perianal fistula: A case report and a brief review of the literature". World Academy of Sciences Journal 8.2 (2026): 32.
Chicago
Latif, S., Ghalib, O. H., Fateh, S. M., Salih, S. H., Ali, R. M., Hama Hussein, K. F., Ahmad, K. A., Abdullah, H. O., Abdulkarim, M. M., Kakamad, F. H."Presacral tailgut cyst with complex perianal fistula: A case report and a brief review of the literature". World Academy of Sciences Journal 8, no. 2 (2026): 32. https://doi.org/10.3892/wasj.2026.447
Copy and paste a formatted citation
x
Spandidos Publications style
Latif S, Ghalib OH, Fateh SM, Salih SH, Ali RM, Hama Hussein KF, Ahmad KA, Abdullah HO, Abdulkarim MM, Kakamad FH, Kakamad FH, et al: Presacral tailgut cyst with complex perianal fistula: A case report and a brief review of the literature. World Acad Sci J 8: 32, 2026.
APA
Latif, S., Ghalib, O.H., Fateh, S.M., Salih, S.H., Ali, R.M., Hama Hussein, K.F. ... Kakamad, F.H. (2026). Presacral tailgut cyst with complex perianal fistula: A case report and a brief review of the literature. World Academy of Sciences Journal, 8, 32. https://doi.org/10.3892/wasj.2026.447
MLA
Latif, S., Ghalib, O. H., Fateh, S. M., Salih, S. H., Ali, R. M., Hama Hussein, K. F., Ahmad, K. A., Abdullah, H. O., Abdulkarim, M. M., Kakamad, F. H."Presacral tailgut cyst with complex perianal fistula: A case report and a brief review of the literature". World Academy of Sciences Journal 8.2 (2026): 32.
Chicago
Latif, S., Ghalib, O. H., Fateh, S. M., Salih, S. H., Ali, R. M., Hama Hussein, K. F., Ahmad, K. A., Abdullah, H. O., Abdulkarim, M. M., Kakamad, F. H."Presacral tailgut cyst with complex perianal fistula: A case report and a brief review of the literature". World Academy of Sciences Journal 8, no. 2 (2026): 32. https://doi.org/10.3892/wasj.2026.447
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