S2252 Rare Rectal Roadblocks - Bowel Obstruction Caused by Tailgut Duplication Cyst

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Introduction: Tailgut Duplication Cysts (cystic hamartomas) are congenital tissue remnants of the embryonic hindgut that can result in significant clinical consequences including mass effect on internal organs and malignant transformation. Diagnosis of retro-rectal cysts is difficult owning to their rare clinical incidence and prolonged asymptomatic nature. Our case outlines a 63-year-old man admitted for coronary artery bypass, who developed severe post-operative abdominal distention and found to have significant intestinal dilation with rectal outlet obstruction caused by a tailgut duplication cyst. Case Description/Methods: A 63-year-old man with history of hypertension developed increased frequency of loose watery stools 2 days after undergoing elective coronary artery bypass surgery. Pathogen testing was negative for Clostridioides difficile infection and supportive care was pursued. On Post-operative day 6, the patient developed abdominal distention and pain with abdominal Xray imaging revealing gaseous dilation of colonic bowel loops measuring up to 9.1 cm in greatest diameter at the hepatic flexure. Surgical team pursued management of ileus with nasogastric tube suctioning and bowel rest. Delayed improvement over the following day with ongoing pain prompted abdominal CT imaging which revealed a 12.7 cm presacral mass containing areas of nodular hyperdensity along the periphery of the mass. This mass exerted mass effect on the rectosigmoid colon. The GI team pursued endoscopic decompression of massively dilated bowel loops with placement of a marcon colonic decompression tube. Follow up clinical exam the following day revealed tense tympanic abdomen with worsened pain that prompted urgent surgical exploration. Exploratory laparotomy revealed a descending colon perforation with 1.3 liters of stool in the abdomen. The patient received a subtotal colectomy with formation of end ileostomy and subcutaneous wound vac placement. The patient had uneventful postoperative recovery with plans undergo sacral mass biopsy as an outpatient by interventional radiology (Figure 1). Discussion: Our case highlights the clinical complications of underlying cystic hamartomas. These masses should be considered in the differential diagnosis of patients presenting with intestinal outlet obstructive symptoms in the setting of large pelvic masses. Surgical excision is the preferred management approach as literature reports have noted malignant transformation in up to 13% of Tailgut cysts.Figure 1.: Tailgut cyst causing bowel obstruction.

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