Presacral space

Last revised by Zemar Vajuhudeen on 12 Dec 2021

The presacral space is located between the rectum and the sacrococcygeal part of the spine.

The presacral space contains a variety of tissue:

  • fat
  • mesenchymal tissue
  • lymph nodes
  • nerve plexuses
  • blood vessels
  • superior - peritoneal reflections
  • inferior - levator ani and coccygeus muscles
  • anterior - rectum (posterior wall)
  • posterior - sacrum / coccyx
  • laterally - ureter, iliac vessels 1

An increase in the width of the presacral space measurement is considered indicative of pathology in the rectum or other structures in the pelvis. This alteration is usually seen in barium enema studies and on plain film. 

The upper limits of normal for the presacral space width is 15 mm in patients younger than 45 years old 2. However, some patients have measurements over 15 mm with no apparent reason (fewer still have 'normal' measurements above 20 mm), which increases with older age. Factors such as sex and weight of the patient should also be taken into consideration 2.

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