Surgical management of a large sacrococcygeal chordoma complicated by rectal perforation: A case report

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Background: Sacral chordomas are rare malignant bone tumors that are locally aggressive and difficult to treat due to proximity to pelvic viscera, neurovascular structures, and the high risk of surgical morbidity. En bloc resection with negative margins remains the gold standard, but it is often not feasible in large or adherent tumors. Rectal perforation is a rare yet potentially catastrophic intraoperative complication that remains sparsely reported. Case Description: We report the case of a 70-year-old man presenting with progressive back and gluteal pain, urinary difficulty, and bowel dysfunction. Magnetic resonance imaging revealed a giant sacrococcygeal chordoma (16.2 × 12.2 × 11.7 cm) compressing the rectum and sacral canal. Pre-operative arterial embolization of the bilateral internal iliac, median sacral, and feeding arteries was performed. During intralesional resection through a posterior approach, a rectal microperforation was detected, prompting intraoperative consultation with the general surgery team. The defect was repaired, and a trephine sigmoid colostomy was created. Tumor debulking was completed with an estimated blood loss of 300 mL. Histopathology confirmed chordoma. The patient recovered well, with a functional stoma and satisfactory wound healing. Conclusion: resection, may risk rectal perforation due to visceral adherence. Prompt intraoperative recognition and management of this adverse event are critical, along with a multidisciplinary approach to maximize patient safety.

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