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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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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
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaps.JIAPS_371_20

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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

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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

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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.

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Conflicts of interest

There are no conflicts of interest.

   References Top

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
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
Rossi UG, Cariati M, Tomà P. Giant sacrococcygeal teratoma embolization. Indian J Radiol Imaging 2013;23:145-7.  Back to cited text no. 3
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