Vaginal wall cyst or rectocele? A case of misleading presentation

Vaginal wall cysts are rare entities that can clinically mimic pelvic organ prolapse, particularly rectocele, due to their posterior location and size. Accurate differentiation is crucial for appropriate management. We present the case of a forty year old multiparous woman who reported a long-standing vaginal mass, recently associated with pelvic discomfort, painful defecation, and urinary difficulty. Clinical examination revealed a large posterior vaginal wall mass, which was initially suspected to be a rectocele. Pelvic MRI showed a well-defined cystic lesion displacing adjacent structures, and surgical excision was performed. Histopathological analysis confirmed an epithelial inclusion cyst. This case highlights the importance of considering vaginal wall cysts in the differential diagnosis of posterior vaginal bulges. Comprehensive clinical evaluation, imaging, and histopathological confirmation are essential for accurate diagnosis and management, thereby preventing misdiagnosis and ensuring optimal patient outcomes.