Sacrococcygeal Teratoma With a Unique Gastrointestinal Presentation of Necrotizing Enterocolitis

A neonate with an antenatally detected mass in the coccygeal region experienced sudden abdominal worsening, with abdominal distension and bloody aspirates on day 4 of life. The abdominal radiograph revealed pneumatosis intestinalis (necrotizing enterocolitis stage IIa), requiring discontinuation of feeds and initiation of intravenous antibiotics. Computed tomography of the mass and abdomen showed that the coccygeal mass had an intra-abdominal extension, pushing the bowel loops and likely representing a Type II sacrococcygeal teratoma. Given the lesion's large size and vascularity, we hypothesize that chronic bowel compression with vascular steal may have contributed to gut ischemia, stasis, and subsequent necrotizing enterocolitis. The mass was excised, and the neonate subsequently remained asymptomatic. This is the first reported case of necrotizing enterocolitis in the setting of a sacrococcygeal teratoma in a neonate. This case also underscores the importance of vigilant monitoring of neonates with sacrococcygeal teratoma for complications arising from its mass effect apart from routine hemodynamic monitoring.