WOFAPS 2025 8th World Congress of Pediatric Surgery

Yasmine Ghazaly, Ahmed Khairy

Alexandria University Faculty of Medicine, Department of Pediatric Surgery, Alexandria, Egypt

Introduction:

Intra-abdominal masses in the neonatal period are quite common, being found in approximately one in every 1000 live births. Germ cells tumors, including teratomas, account for 9% of all intra-abdominal tumors in children. Teratomas are a type of germ cell tumor that contains embryological tissues from all the three germ cell layers. The teratoma sites of predilection are the sacrococcygeal (60–65%), gonadal (10–20%), mediastinal (5–10%), presacral (5%), retroperitoneal, cervical, and rarely the intracranial regions. Rarely, teratomas are localized to abdominal organs accounting for less than 1% of all teratomas.

We report a case of three month-old male infant who was complaining of progressive abdominal distension since birth and non-bilious vomiting. On exploration large mesenteric mass about (20 ×20 × 10 cm) weighing (2.200 kg) arising near the root of mesentery of the small bowel with an ileal segment about 25 cm attached to it. The histopathological examination showed grade II immature teratoma.

Case presentation:

A Three -month-old male infant weighted 7.500 Kg, born at full term caesarian section delivery, presented to the pediatric surgery outpatient department of El-Shatby university Hospital, Alexandria University, Egypt, with progressively enlarging abdominal distension since birth and recurrent attacks of non-bilious vomiting. On examination, the abdomen was markedly distended, no tenderness and a palpable mass occupying almost whole abdomen. An abdominal ultrasound was done revealed a sizable heterogeneous pelvi-abdominal mass 8.8 x14.4 cm showing multiple areas of cystic changes with detected vascularity on color Doppler seen inseparable from left lobe of the liver and minimal free turbid intra-peritoneal fluid. CECT scan showed large solid and cystic mass with internal septations measured 13x 16x13.5 cm displacing small bowel loops. The mass is extending from the epigastrium downward to the pelvis. Features are suggestive of a rare benign intra-abdominal mass of infancy mostly intra-abdominal teratoma.Tumor markers levels showed raised Alfa fetoprotein 80 ng/ml (normal 0–8 ng/ml) and normal β Hcg

Method and results:

Intra-operatively, exploratory laparotomy through extended right transverse incision revealed large mesenteric mass about (20 ×20 × 10 cm) weighing (2.200 kg) arising near the root of mesentery of the small bowel with an ileal segment about 25 cm attached to it, 20 cm from ileocaecal valve. Meticulous dissection and complete resection of the mass from the attached ileal segment without any ileal resection.(Fig.2) The operation went well, the patient started oral feeding in the 2nd postoperative day and discharged after achieving full oral feeding with no problems.

Histopathological examination revealed a mass with multicystic spaces lined with keratinized stratified squamous epithelium with scattered intestinal glands, salivary glands, cystic spaces lined with mucin secreting cells, fat cell and brain tissue with atypia and increased mitotic activity. Features consistent with grade II immature teratoma.

Conclusion:

teratomas, account for 9% of all intra-abdominal tumors in children. Rarely, teratomas are localized to abdominal organs accounting for less than 1% of all teratomas. In the known literature, only 22 cases of mesenteric teratoma were reported and the youngest patient reported in the literature is a one month old girl by Srivastava and Ghritlaharey in 2011. We believed that this is the only case of such a large size for immature teratoma in a young infant.