ABSTRACT
The presacral or retrorectal space is a potential location for a variety of tumours that originate from one or more of the three germ cell layers. Tumours can be cystic or solid, and benign or malignant. The reported <1% incidence of these tumours is likely an underestimate as patients often present with minimal or non-specific symptoms given the indolent nature of these tumours. Tumours in the presacral space that arise from, or secondarily involve, neural structures may lead to symptoms consistent with particular pelvic nerve distributions. Moreover, patients should be counselled regarding potential neurological or musculoskeletal deficits following surgery. Symptoms of presacral tumours are often non-specific and these are often identified incidentally during routine pelvic or rectal examination. Those patients with symptoms frequently describe long-standing vague perineal, rectal or low back pain. It has been reported that the presence of pain is far more common when the pathology is malignant compared to benign.
