The congenital presacral epidermoid cyst is an exceedingly rare pelvic tumor. It is a type of inclusion cyst, which probably results from cells which are detached from the anal plate, when the latter is canalized to form the anal canal. Such a cyst may remain silent for years, to be unexpectedly encountered at the time of labor or a pelvic laparotomy. Being prone to suppuration, such a cyst may be converted by infection into an abscess. Digital examination of the rectum is essential to diagnosis. The ideal treatment is elective total extirpation through a longitudinal parasacral incision, which includes coccygectomy. An infected cyst should be treated by incision and drainage. From an obstetrical standpoint, most patients may safety be delivered per vaginam, although cesarean section is indicated in the event of dystocia.