Teratomas are rare in neonates. They are embryonic neoplasms containing elements from all the three germ layers. Commonly, they arise in the ovary and testis. Rarely do they arise from the gastrointestinal tract, as in our case. Intestinal obstruction in neonates is usually due to congenital obstructive malformation such as atresia and/or stenosis of the gastrointestinal tract with or without sepsis.
An outborn 5-day neonate, generally well before admission presented with non-bilious vomiting, abdominal distension and a palpable mass extending from the right to left flank across the centre. Bilious aspirates/vomiting usually indicates obstruction distal to the ampulla of Vater. Clear aspirates indicate obstruction proximal to the ampulla which usually present by second day of life.
Possibility of a mass lesion such as a “teratoma” causing gastrointestinal obstruction needs a high index of suspicion. Imaging studies of plain X-ray chest with abdomen enhanced our clinical suspicion which was promptly followed by ultrasonography of the abdomen and thereafter computerized tomography of the abdomen which provided corroborative evidence. Laparotomy on the seventh day of life confirmed the clinical suspicion and imaging evidence of an exogastric mass arising from the postero-inferior wall of the stomach along its greater curvature. Histopathology revealed a mature teratoma.
A high index of clinical suspicion by the paediatrician/neonatologist attending a neonate with abdominal distension suggestive of gastrointestinal obstruction, immediate cardiopulmonary, hemodynamic and circulatory stabilization, followed by prompt and appropriate imaging studies with timely surgical consultation holds the key to quality outcome.