Para-rectal presacral masses, though rare in clinical practice pose a diagnostic and therapeutic challenge to surgeons. Symptoms if present are usually associated with mass effect on rectum or lower urinary tract. Pre-operative diagnosis using imaging modalities may be misleading. The role of pathological diagnosis is debatable as complete surgical excision is the mainstay of management. The surgical approaches may vary depending upon site, size, relation to rectal wall, sacral vertebra and presence of abdominal component of the lesion. In this case report, we present an elderly lady who presented with a swelling in the coccygeal area associated with discomfort and how we went ahead with management.
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