An extremely rare complication of Meckel's diverticulum: enterocutaneous fistulization of umbilical hernia

elements or potentiality for malignant degeneration in the medium term, and the risk of infection in benign cysts. This patient was discharged on the seventh postoperative day, with uneventful recovery. The resection of the coccyx is not recommended unless there is suspicion of involvement by malignant disease3. As far as rectum is often densely adhered to the tumor, should be carried out careful dissection, to avoid injury. There are three types of surgical approach: anterior or abdominal transperitoneal or extra-peritoneal, conventional or laparoscopic access; the posterior approach; and combined abdominosacral route. The anterior approach is used for high lesions (with caudal end until the level S4) without evidence of sacral engagement. The rectum is folded laterally and the median sacral artery is usually linked with the dissection and tumor is enucleated2. The latter approach is preferred for smaller, benign lesions that do not extend beyond the level S4. This route is used when the presence of neural involvement or for better viewing and preservation1. Tumors of major proportions exceeding proximal and distal S4 level are more easily operated via abdominosacral2 route. The resection can be performed synchronously with the patient in the lateral position or sequentially with the change in position after each stage of the operation. The benefit of the combined approach includes the ability to display structures such as ureter, nerve and sacral iliac vessels, particularly important in cases where there is the need to perform partial sacrectomy, especially in chordoma. The adjuvant therapies have only a secondary role in the management of tumors in retrorectal space. In cases where radical surgery is contraindicated, palliative radiotherapy has been carried out, except for chordoma, classically radioresistant. The survival of benign tumors approaches to 100% in most studies7. However relapse is not uncommon. Development of cysts relapses up to 15%1. Approximately 9-45% of retrorectal malignant tumors are most commonly solids than cystic, with recurrence rates of 45%; five year survival rate is about 8 to 17%.