Surgical evaluation and management of infected tailgut cysts in pediatrics: A case series

Introduction

Tailgut cysts are lesions occurring in the presacral space that most commonly present in early adulthood but can be identified in the pediatric population. Superimposed infection is even more rare which can lead to diagnostic and treatment uncertainty when encountered.

Case presentations

Patient 1 was an 8-year-old male who originally presented with lower abdominal pain and fevers. A computed tomography (CT) scan was performed identifying a 2.8 cm presacral fluid collection. Definitive management via posterior midline approach with coccygectomy was performed. He subsequently developed a small fluid collection that resolved with antibiotics. Patient 2 was a 15-year-old male who presented from an outside institution after CT revealed a presacral abscess. Attempts at transgluteal drain were unsuccessful. Subsequently, he was taken to the operating room, were an anterior, laparoscopic approach was used to partially excise the presacral cyst. After recurrence, a posterior approach with coccygectomy was performed with resolution of the cyst. Patient 3 was a 10-year-old female who was found to have a 4.3 cm presacral abscess that recurred after surgical drainage at an outside institution. The patient was taken to the operating room, where a posterior midline approach with coccygectomy was performed with resolution of the cyst.

Conclusion

Complete surgical excision appears to be the most definitive treatment modality for infected tailgut cysts with our preferred approach through the posterior sagittal midline. While rare, tailgut cysts should remain in the differential for any recurrent or new complex presacral infection resistant to standard medical and surgical treatment.