PMC4818308_01
Sagittal magnetic resonance imaging (MRI) of the pelvis showing a presacral tumour. The inhomogeneously enhancing tumour (maximal diameter of 7 cm) has contact to the sacralforamina S3/S4 on the right side and shows partial osseous destruction. There are no signs of rectal infiltration.
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Further diagnostic imaging revealed an infiltration of the neuroforamina in level S4 partly intraspinal, partly parasacral (Fig. 1).
Two years after neurinoma resection. (A) Lateral X-ray picture of the pelvis showing an inflated mass behind the sacrum (circled). (B) Sagittal MRI scan showing a large bowel prolapse through sacrum defect (arrow).
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X-ray examination of the pelvis showed an inflated mass behind the sacrum (Fig. 2A). Magnetic resonance imaging (MRI) revealed a huge rectocele through a sacral defect extending into the subcutaneous tissue (Fig. 2B).
Intraoperative findings. (A) Note exposed prolapse orifice (arrow) and dorsal mesorectum (*). (B) Repair with mesh graft and spiral tacks.
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Therefore, a mesh graft (ProGripTM, Laparoscopic Self-Fixating Mesh, Covidien Surgical Solutions, Mansfield, USA) was implanted and fixated with tacks (ProtackTM, Covidien Surgical Solutions, Mansfield, USA) (Fig. 3A,B).
Five months after defect repair, MRI scan showing a good postoperative result. Scare changes are visible in the place of former rectocele, without signs of persisting prolapse.
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Only scar changes were visible after elimination of the sacral rectocele (Fig. 4).