Type IV sacrococcygeal teratomas (SCTs) are the rarest subtype of SCTs. We report a 2-week-old female who presented to a tertiary care centre in Muscat, Oman, in 2024 with abdominal distension and feeding intolerance. Imaging revealed a purely cystic presacral lesion, managed with successful laparoscopic-assisted cyst excision and coccygectomy. Histopathology confirmed a mature cystic SCT and the patient was diagnosed with a purely cystic Altman type IV SCT. The postoperative course was uneventful apart from minor wound dehiscence, which resolved with conservative management. Follow-up showed complete wound healing and no recurrence. Purely cystic Type IV SCTs are extremely rare and challenging to diagnose due to their benign radiological appearance and lack of external manifestations. Complete surgical excision with coccygectomy remains the cornerstone of treatment; laparoscopic-assisted excision in neonates is feasible and safe.
Almaawali et al. (2026) studied this question.