title: Perineal approach for surgical treatment in a patient with retro-rectal tumor: a case report and review of the literature.
abstract: BACKGROUND
  Retrorectal tumors in adults are very rare and little known condition. These tumors, often misdiagnosed or mistreated, should be completely excised because of the potential for malignancy or infection. A suitable operative approach is the key to the successful surgical management.
  
  
  METHODS
  We report the case of a 45-year-old Arab male who presented with chronic pelvic pain accompanied by straining to defecate and dysuria. The clinical examination showed a painless mass in the left perineal area. Pelvic magnetic resonance imaging and computed tomography scan demonstrated a huge and well-limited pelvic mass causing displacement and compression of the rectum and bladder. Although the large size of the mass (>7 cm in the greater diameter), it was successfully and completely excised through only perineal approach without undertaking coccygectomy or sacrectomy. The histopathological study revealed a low-grade leiomyosarcoma. The patient is currently in 4-years follow-up with no signs of recurrence or metastasis.
  
  
  CONCLUSIONS
  Even large retro-rectal tumors may be successfully excised by the perineal approach especially in carefully selected patients, but require extensive knowledge of pelvic anatomy and expertise in pelvic surgery.
authors.affiliation: Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco. mtarchouli@gmail.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tarchouli
authors.affiliation: Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco. zentaraziz66@hotmail.com.
authors.forename: Aziz
authors.initials: A
authors.lastname: Zentar
authors.affiliation: Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco. ratbi-ibrahim@live.fr.
authors.forename: Moulay Brahim
authors.initials: MB
authors.lastname: Ratbi
authors.affiliation: Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco. abdelbensal@gmail.com.
authors.forename: Abdelhak
authors.initials: A
authors.lastname: Bensal
authors.affiliation: Department of Oncology, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco. redastos@hotmail.com.
authors.forename: Mohamed Reda
authors.initials: MR
authors.lastname: Khmamouche
authors.affiliation: Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco. aitali.mounain@gmail.com.
authors.forename: Abdelmounaim Ait
authors.initials: AA
authors.lastname: Ali
authors.affiliation: Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco. ahmed.bounaim@yahoo.fr.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bounaim
authors.affiliation: Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco. elfahssi.mohammed@hotmail.com.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Elfahssi
authors.affiliation: Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco. khalid_sair@yahoo.fr.
authors.forename: Khalid
authors.initials: K
authors.lastname: Sair
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis / Q000503:physiopathology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D053159:Dysuria / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007890:Leiomyosarcoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000473:pathology / Q000601:surgery*; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome