A case of deep endometriosis with cyst formation as a differential diagnosis of rectal duplication cyst in the presacral space

Cysts occurring in the presacral space may become malignant and therefore require surgical removal. A wide variety of cystic lesions can occur in the presacral space, such as tailgut cysts, dermoid cysts, and duplication cysts. However, deep endometriosis with cyst formation in the presacral space is extremely rare. Here, we report a case of deep endometriosis that presented characteristic imaging and pathological findings and required a differential diagnosis of rectal duplication cyst. A 49-year-old female was referred with a chief complaint of lower abdominal pain. Magnetic resonance imaging (MRI) revealed a cystic lesion with a three-layered wall structure on the right side of the rectum, suggesting a rectal duplication cyst. The lesion had a maximum diameter of 8 cm and extended from the lower end of the second sacral vertebra to the levator ani muscle. The cystic lesion was removed laparoscopically, and intraoperative findings revealed no communication between the cystic lesion and the rectum. We found that the wall of the deep endometriosis with cyst formation had a histopathological three-layered structure and considered that the layered structure closely resembled the intestinal wall on MRI. Deep endometriosis should be recognized as a differential diagnosis of cystic lesions in the presacral space. Similar content being viewed by others Abbreviations - MRI: - Magnetic resonance imaging - CT: - Computed tomography - S3: - The third sacral vertebra

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We want to particularly acknowledge Professor Riuko Ohashi of the Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences for her comprehensive advice on pathological diagnosis, and Dr. Yukari Goto of Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences for her comprehensive advice on radiological diagnosis. Funding The authors declare that they have no current financial arrangement or affiliation with any organization which may have a direct influence on their work. Author information Authors and Affiliations Contributions All authors made substantial contribution to the preparation of this manuscript and approved the final version for submission. MN: drafted the manuscript; YS: corresponding author; HO, AM, MN, SK, RG, NY, and KY: clinical support; TW: careful review and final approval of the manuscript. Corresponding author Ethics declarations Conflict of interest The authors declare that they have no current financial arrangement or affiliation with any organization which may have a direct influence on their work. Ethical approval The study was reviewed and approved by the Institutional Review Board of Niigata University (2018–0137). Consent for publication Written informed consent was obtained from the patient for publication of this case report and accompanying images. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Nakano, M., Shimada, Y., Ozeki, H. et al. A case of deep endometriosis with cyst formation as a differential diagnosis of rectal duplication cyst in the presacral space. Clin J Gastroenterol 18, 330–336 (2025). https://doi.org/10.1007/s12328-025-02100-7 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s12328-025-02100-7