Stavros Loukogeorgakis1, Simona Rusu1, Mark Thomas2, Muhammad Choudhry1
1Department of Paediatric Surgery and Urology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom. 2Department of Neonatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom


Sacrococcygeal teratoma (SCT) is the most common neoplasm in neonates. Although most SCT can be resected with the patient in the prone/jack-knife position, SCT with significant intra-pelvic/abdominal components (Altman type III or IV) require laparotomy/laparoscopy for safe and successful tumour resection.

Here we present a case of an intra-pelvic/abdominal sacrococcygeal mass in a female neonate. The mass was detected during antenatal ultrasound imaging at 21 weeks gestation and was cystic in nature. The child was born in good condition at 39 weeks gestation by spontaneous vaginal delivery and her birth weight was 3.5kg. Clinical examination demonstrated a small irregular mass in the sacral area, but was otherwise unremarkable. An MRI was performed at day 2 of life that showed a large multi-septated predominantly cystic dumbbell shaped sacral mass measuring 7.3*5.4*3.2cm (Figure A). The mass originated from the sacrum/coccyx, and extended into the pelvis inferiorly and the aortic bifurcation superiorly, consistent with an Altman type IV SCT. Baseline alpha fetoprotein (AFP) was 2.5*104ng/mL, and beta human chorionic gonadotropin (βHCG) was undetectable. Intra-operatively, laparoscopy was utilised to obtain vascular control (clipping of the median sacral artery; Figure B), as well as dissect the tumour from the lower-abdominal and pelvic viscera. Following this, the child was placed in the prone/jack-knife position, and the tumour was resected en-bloc with the coccyx via a modified chevron incision (Figure C, D). A superficial wound dehiscence that was noted at day 5 following surgery was managed conservatively, and the child was discharged home without any significant concerns. Histological analysis confirmed the diagnosis of a mature teratoma. The child is currently well, with a good cosmetic result and no evidence of recurrence.

Laparoscopy could be utilised as an adjunct for the safe and effective resection of predominantly intra-pelvic/abdominal neonatal SCT.