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Sacrococcygeal teratoma (SCT) is an uncommon tumor seen in the newborn occurring in 1 per 35,000 to 40,000 live births. The diagnosis is frequently made prenatally although a delayed presentation, which adversely impacts prognosis, can be seen in patients with intra-abdominal lesions.
Multiple factors make the management of SCT challenging for the pediatric surgeon. SCTs are often highly vascular large lesions that arise from the coccyx. The vascularity of the lesions can lead to high output cardiac failure. If this occurs in the prenatal period fetal hydrops results. If left untreated, this almost always results in fetal demise . Postnatally, the vascularity of the tumor can lead to high output cardiac failure in the neonate with hemodynamic instability which necessitates emergent resection prior to advanced imaging. The lesions are large and abut the anus and rectum making surgical resection difficult. Lifelong difficulty with voiding and defecation can result.
Given their malignant potential, complete resection is necessary. SCTs that extend into the abdomen are difficult to completely resect and sometimes require an approach from both the sacrum and abdomen .