Home | About Us | Current Issue | Ahead of print | Archives | Search | Instructions | Subscription | Feedback | Editorial Board | e-Alerts | Login 
Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
 Users Online:1305 
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size


 
Table of Contents   
CLINICAL IMAGE
Year : 2021  |  Volume : 26  |  Issue : 4  |  Page : 274-275
 

Spontaneous necrosis in a type I sacrococcygeal teratoma


1 Department of Paediatric Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh; Department of Paediatric Surgery, GMCH, Nagpur, Maharashtra, India
2 Department of Paediatric Surgery, GMCH, Nagpur, Maharashtra, India

Date of Submission25-Jan-2021
Date of Decision25-Jan-2021
Date of Acceptance03-Feb-2021
Date of Web Publication12-Jul-2021

Correspondence Address:
Dr. Charu Tiwari
Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh - 492 099
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_371_20

Rights and Permissions

 



How to cite this article:
Tiwari C, Nagdeve N, Saoji R. Spontaneous necrosis in a type I sacrococcygeal teratoma. J Indian Assoc Pediatr Surg 2021;26:274-5

How to cite this URL:
Tiwari C, Nagdeve N, Saoji R. Spontaneous necrosis in a type I sacrococcygeal teratoma. J Indian Assoc Pediatr Surg [serial online] 2021 [cited 2021 Jul 30];26:274-5. Available from: https://www.jiaps.com/text.asp?2021/26/4/274/321196





   Case Summary Top


A 2-day-old female neonate was admitted for the management of a Type I sacrococcygeal teratoma (SCT). Antenatal ultrasound had suggested the presence of SCT in the fetus. The birth weight of the baby including SCT was 3.5 kg. At admission, her vitals were stable and the SCT was approximately 15 cm × 10 cm with a pedicled base [Figure 1].
Figure 1: Large sacrococcygeal teratoma undergoing spontaneous a b necrosis

Click here to view


Computed tomography suggested Altman Type I SCT. The baby was planned for elective surgical removal. However, on the morning of surgery, the tumor had become necrotic [Figure 1], probably due to torsion of the pedicle hampering blood supply and causing ischemia. The baby underwent removal of the remaining SCT along with coccygectomy [Figure 2]. Histopathology confirmed mature teratoma. She is on regular follow-up and asymptomatic.
Figure 2: Immediate postoperative image and excised specimen

Click here to view


A large SCT poses a therapeutic challenge.[1] Early surgery (tumor resection with coccygectomy) is recommended; the approach being determined by the size of tumor and type of SCT. Intraoperative uncontrolled bleeding and hemodynamic instability can be life-threatening. Literature suggests tumor devascularization after ligation of the middle sacral artery before tumor removal.[1] Few reports also suggest preoperative endovascular embolization of the hypertrophic middle sacral artery supplying the SCT, leading to tumor ischemia and necrosis.[1],[2],[3]

Our case was unique that preoperative devascularization occurred naturally by torsion of the pedicle; the SCT became necrosed and subsequent surgery became simple; this may pave way for better management of large SCTs in future.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the child's parents have given consent for images and other clinical information to be reported in the journal. The child's parents understand that the name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Guitart J, Teixidor M, Brun N, López S, Criado E, Romero N. Preoperative giant sacrococcygeal teratoma embolization in a newborn-A case report and a review. Cir Pediatr 2020;33:95-8.  Back to cited text no. 1
    
2.
Lahdes-Vasama TT, Korhonen PH, Seppänen JM, Tammela OK, Iber T. Preoperative embolization of giant sacrococcygeal teratoma in a premature newborn. J Pediatr Surg 2011;46:e5-8.  Back to cited text no. 2
    
3.
Rossi UG, Cariati M, Tomà P. Giant sacrococcygeal teratoma embolization. Indian J Radiol Imaging 2013;23:145-7.  Back to cited text no. 3
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article

    

 
  Search
 
  
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (692 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


   Case Summary
    References
    Article Figures

 Article Access Statistics
    Viewed118    
    Printed0    
    Emailed0    
    PDF Downloaded17    
    Comments [Add]    

Recommend this journal


Contact us | Sitemap | Advertise | What's New | Copyright and Disclaimer 

  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

Online since 1st May '05