[A case report of sacral chordoma].

Sacrococcygeal chordoma is one of the retrorectal tumors. Relative rarity and anatomical location of this may lead to difficulty in diagnosis and surgical treatment. We report a case of sacrococcygeal chordoma successfully treated by high sacral resection by a posterior approach, in which the co-operative efforts of gastroenterological surgeons and an orthopedic surgeon were employed. A 64-year-old man with a long term continued vague anal pain was referred to our hospital. Digital rectal examination revealed an elastic hard mass presacrally. Plain sagittal radiograph, CT, barium enema showed a retrorectal mass and sacral destruction. Diagnosis was confirmed histologically by the specimen taken by open biopsy. Surgical resection was carried out in prone position with the buttocks elevated. The skin incision was upward arched transverse. The lower sacral vertebrae, including S3, were removed en block with the tumor. Bilateral S3 sacral nerve roots were preserved. Postoperative disturbances of the urination and defecation were not seen. High dose radiation therapy, 80 Gray, was done after surgery. Radiation ulcer of the skin was treated by free skin graft, but radiation proctocolitis was not seen. Now he is free from the disease.