Transcoccygeal resection for a presacral GIST of the distal rectum

Gastrointestinal stromal tumours (GISTs) of the rectum are rare and comprise about 5% of all GISTs. Workup includes biopsy with immunohistochemistry analysis. Surgical excision is the standard treatment, although tyrosine kinase inhibitors, particularly imatinib, are known to be useful in the neoadjuvant and adjuvant settings. We present a case of a woman in her 70s who was diagnosed with distal rectal GIST. MRI revealed the tumour to be located within the presacral space. She underwent core needle biopsy with immunohistochemistry confirming KIT-positive GIST. The patient received neoadjuvant imatinib therapy, followed by surgical excision via the transcoccygeal approach (Kraske procedure). She recovered appropriately and went on to receive adjuvant imatinib therapy. We describe the progression of this patient's care and review various pertinent therapies for distal rectal GIST, highlighting the transcoccygeal resection as a safe and effective approach.