Teaching Case

Vomiting and refusing to drink for two weeks. History of premature birth.

The premature girl was admitted to the hospital because of vomiting and refusing to drink for two weeks. Physical examination and laboratory tests were normal. A barium follow through examination revealed an anterior displacement of the rectosigmoid. US disclosed a huge presacral mass, which was further evaluated by CT scan and IV urography.

Teratomas are common, usually benign, abdominal masses in the pediatric age group that may be found at different sites within the abdomen and pelvis. The most common location in childhood is presacral. Sacrococcygeal teratoma occurs in about one per 35.000 newborns with a four times more frequent occurrence in females. The etiology of the tumor is unknown. On conventional radiographic examinations the tumor presents as a soft tissue mass with calcification in 60% of the cases. The rectum is usually displaced anteriorly, the bladder may be compressed and distorted by the mass. Urography should be performed in all cases to exclude urinary involvement, especially in malignant forms of teratomas. CT and MRI precisely delineate the extent of the tumor within the pelvis and its relationship to the adjacent structures. There is evidence that these tumors undergo malignant degeneration in elderly children, therefore early diagnosis and surgical removal is mandatory. The differential diagnosis of sacrococcygeal tumors in the neonate should include liomas, lipomeningoceles, hemangiomas, epidermal cysts, sarcomas and rectal duplication cysts.