Abstract
Presacral tumors are uncommon lesions located between the rectum and sacrum; developmental cysts account for 50-75% of cases. Bilateral presacral tumors are exceedingly rare. A 32-year-old woman presented to the First People's Hospital of Xiaoshan District (Hangzhou, China) with abdominal pain. A digital rectal examination revealed a firm, fixed mass on the posterolateral rectal wall. Magnetic resonance imaging (MRI) was employed, leading to the identification of bilateral presacral lesions. A complete excision was performed via a posterior sacral approach under general anesthesia. The patient recovered well; wound healing was found to be satisfactory, and no recurrence was observed at the 12-month follow-up. In conclusion, the current report presents a rare case of bilateral presacral epidermoid cysts. Precise preoperative characterization by MRI and careful surgical planning enabled successful resection. The case emphasizes the importance of tailored surgical strategies in the treatment of rare presacral lesions.