WOFAPS 2025 8th World Congress of Pediatric Surgery

Saiyeda Mahin Fatima ¹, Shabbir Hussain ², Mehak Fatima ²

¹ Liquat National Hospital
² Liaquat National Hospital

Presacral masses are rare, with an estimated incidence of 1.4–6.3 cases annually in adults and even fewer in children. The majority are congenital in origin and represent a wide spectrum of pathologies, including neoplastic lesions such as germ cell and neurogenic tumors, development cysts, and infectious causes. Sacrococcygeal teratomas are the most commonly encountered type in the pediatric population. Diagnosing presacral tumors can be challenging due to their nonspecific clinical presentation, most notably chronic constipation, which often leads to delays in recognition and treatment. We report four pediatric cases of presacral masses presenting with persistent constipation over a one-year period. The underlying diagnoses included an immature teratoma, a mixed germ cell tumor, a ganglioneuroblastoma, and a hydatid cyst. In all cases, diagnosis was delayed due to the absence of externally visible signs and the nonspecific nature of symptoms. Each patient underwent thorough clinical evaluation, imaging, and upfront surgical excision. These cases underscore the importance of maintaining a high index of suspicion for presacral masses in children with refractory constipation. Careful history-taking and physical examination, including digital rectal examination, are critical, as the majority of these masses are palpable despite their deep location. Early recognition and appropriate imaging can facilitate timely intervention and improve outcomes.