The presacral space is the extraperitoneal potential space between the posterior wall of the rectum and the anterior surface of the sacrum, bounded by Waldeyer fascia (presacral fascia) posteriorly and the mesorectal fascia anteriorly. It contains presacral fat, the superior rectal vessels, and the pelvic autonomic nerves. Presacral tumours (teratomas, chordomas, meningoceles) arise here.
| Location | Back of the pelvis, between the rectum and the front of the sacrum and coccyx, outside the peritoneum |
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A bloodless plane that lets the rectum move against the sacrum and is the plane followed in rectal cancer surgery. Injury to the veins under the presacral fascia causes severe bleeding.
The presacral space is the posterior surgical plane in total mesorectal excision for rectal cancer. Presacral tumours presenting as retrorectal space occupying lesions are diverse: dermoid and teratoma cysts are the most common benign lesions; chordoma is the most common malignant primary. CT and MRI characterise the lesion and its sacral involvement. Surgical access to the presacral space is transperineal, transsacral (Kraske approach), or combined abdominal-perineal.
A presacral cyst or mass displaces the posterior rectal wall anteriorly, producing constipation, pelvic pressure, and a smooth posterior rectal bulge on examination; MRI characterises the lesion as cystic or solid and maps sacral involvement, with surgical resection via transsacral or combined abdominal-perineal approach.
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