WOFAPS 2025 8th World Congress of Pediatric Surgery

Varag Abed ¹, Marla Sacks ¹, Carlos Reck ¹, Raavi Gupta ², Harry Zinn ³, Francisca Velcek ¹

¹ Department of General Surgery, Division of Pediatric Surgery, State University of New York Downstate Health Sciences University
² Department of Pathology, State University of New York Downstate Health Sciences University
³ Department of Radiology, State University of New York Downstate Health Sciences University

Introduction: Rectal duplication cysts are rare congenital anomalies, accounting for approximately four percent of all gastrointestinal duplication cysts. The glomus coccygeum is a vascular structure located around the tip of the coccyx. This case report details an adolescent female with a rectal duplication cyst, where incidental dissection of the glomus coccygeum during surgery resulted in unexpected blood loss.

Case Presentation: A 19-year-old female with a history of anal transposition surgery for an imperforate anus and rectoperineal fistula as a newborn presented to the clinic with a four-month history of an enlarging posterior perianal mass with intermittent drainage. Magnetic Resonance Imaging showed a cystic structure, consistent with a congenital duplication cyst. She subsequently underwent excision of the congenital duplication cyst. A tubular cystic structure approximately 6x2.5 centimeters in diameter was present in the superior perianal area draining gray-brown fluid. Surprisingly, there was about 400cc of blood loss during excision. An incidental finding of a glomus body, consistent with a glomus coccygeum, was found during pathological examination.

Conclusion: Rectal duplication cysts are rare congenital anomalies that require careful excision due to their proximity to the glomus coccygeum. Although the glomus coccygeum is infrequently encountered, it is important for surgeons to be familiar with this anatomical structure to minimize the risk of unexpected bleeding.