title: Laparoscopic and perineal excision of an infected "dumb-bell" shaped retrorectal epidermoid cyst.
abstract: BACKGROUND
  Extraperitoneal cysts in the pelvis adjacent to the rectum are rare entities. They are of vague etiology, and the pathologic types of the acquired variety are dermoid, epidermoid, and teratoma. As far as we know, laparoscopic excision of a retrorectal epidermoid cyst has never before been reported.
  
  
  METHODS
  The patient was an elderly lady with a large pelvic cyst and another large cyst in the perineum, which displaced the vagina and the anus. Laparoscopy was performed; the pelvic cyst was punctured and then dissected out. The perineal extension of the cyst was excised via a perineal approach. The patient had an uneventful recovery and was discharged on the 4th postoperative day. Histopathologically, the cyst was of the epidermoid type. Follow-up after 26 months revealed no recurrence.
  
  
  CONCLUSIONS
  Our case presented a diagnostic dilemma. Laparoscopic excision was tedious, though we completed the procedure successfully. Precaution was taken to avoid spillage of the contents and also to avoid injury to vital structures nearby, such as the iliac vessels and ureter. It is feasible to laparoscopically excise retrorectal cysts with a careful and meticulous dissection.
  
  
  CONCLUSIONS
  The major advantages are rapid recovery with minimal morbidity and excellent cosmesis.
authors.affiliation: Department of Minimal Access Surgery, GEM Hospital, Coimbatore, India.
authors.forename: Chinnusamy
authors.initials: C
authors.lastname: Palanivelu
authors.forename: Muthukumaran
authors.initials: M
authors.lastname: Rangarajan
authors.forename: Rangasamy
authors.initials: R
authors.lastname: Senthilkumar
authors.forename: Madhupalayam V
authors.initials: MV
authors.lastname: Madankumar
authors.forename: Shankar
authors.initials: S
authors.lastname: Annapoorni
mesh_terms: D004814:Epidermal Cyst / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010388:Pelvis; D010502:Perineum; D012007:Rectum; D013492:Suppuration