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Cape Town baby has huge tumour removed successfully

There were wide smiles on the faces of Sanel and Mathew Winder of Cape Town when they recently
left Netcare Blaauwberg Hospital, cradling their precious one-month-old baby son, Evan, who they
described as a little miracle.
The couples joy as they prepared to leave the hospital with Evan was all too evident. This is not
surprising when one considers that Evan had to be delivered eight weeks prematurely on 28 January
2015 by emergency caesarean section at the hospital after he had developed life-threatening
complications as a result of a massive tumour. When Evan was delivered, the multi-cystic solid
tumour, which weighed 1.2 kilograms, was a third of his body weight of 3.6 kilograms.
Read: How to predict complications in premature babies
Neonatologist, Dr Ricky Dippenaar, who is world-renowned for his expertise with very premature
neonates and practises at Netcare Blaauwberg Hospital, says that the foetus had developed a rare
form of tumour known as a sacrococcygeal teratoma.
There are different types but this particular one consisted of multiple large cysts and solid areas.
These kinds of tumours can grow very aggressively, and this one had rapidly developed to such a
size that it threatened to compromise normal blood flow to the foetus. If left untreated, it would have
resulted in heart failure and intrauterine death, he explains.
In general, the larger a sacrococcygeal teratoma becomes, the more dangerous it is to the foetus.
Such large foetal tumours can also pose a very real risk to the mother resulting in Mirror syndrome.
Although it was still two months to Evans due date, his condition had started to become critical and
the antenatal foetal assessment team consisting of obstetricians Dr Sarel Brand, who practises at the
Netcare Blaauwberg Hospital, and Dr Lou Pistorius, concluded that Evan had to be delivered
immediately by C-section, notes Dr Dippenaar.
After the successful delivery, the team of neonatal medical specialists stabilised Evan for 24 hours
before the neonatal surgical team led by paediatric anaesthetist, Dr Lance Thompson, and paediatric
surgeon, Professor Daniel Sidler, performed a highly intricate four-hour operation to remove the
tumour. Dr Dippenaar says that the teratoma was one of the largest that any of the members of the
highly experienced medical team had ever seen, and little Evan required multiple blood transfusions
during the lengthy procedure.
The tumour had developed from the babys coccyx, resulting in a maternal response of excessive
amniotic fluid accumulation, further compromising the pregnancy. As it turned out, we could see
that one of the larger cysts had already ruptured, most likely resulting in the dramatic increase in
the amount of amniotic fluid and discomfort Mrs Winder was experiencing. Had the cyst not
ruptured prior to birth, the tumour would have been even larger than it was, points out Dr
Dippenaar.
Sanel, whose first son was delivered at the hospital two years ago, admits that she was terrified
when she was told early in her pregnancy about Evans tumour, which was quite visible in utero with
the aid of a sonar and other medical imaging technology.

Fortunately the medical team at Netcare Blaauwberg Hospital, led by my gynaecologist Dr Sarel
Brand, was extremely supportive and left nothing to chance. They were absolutely remarkable and
kept my husband and I fully informed about the process that was to be followed and the risks
involved. They were also highly professional, reassuring us every step of the way, says Sanel.
Within just a few days of the operation, Evan was feeding and passing stools normally. By last
weekend, his respiratory support had been removed and it was clear he was making a strong
recovery. I am so grateful to the entire medical team whose expertise made it possible for our son to
lead a normal life, and to the nursing staff in the neonatal ICU at Netcare Blaauwberg Hospital who
took special care of him during his month-long stay in hospital, adds Sanel.

Here is an image of baby Evan at Netcare Blaauberg Hospital, this image was supplied:

Dr Dippenaar says that the procedure to remove the large sacrococcygeal teratoma is a highly
specialised one, and should only be performed by a multi-disciplinary team of neonatal experts. The
team who operated on Evan was brought together by Dr Brand and included Dr Dippenaar, Dr
Thompson and Prof Sidler. Prof Abdool Samad Shaik, a highly experienced foetal surgeon who has
performed a number of groundbreaking, minimally invasive in-utero operations on foetuses in recent
years at the Netcare Parklands Hospital in Durban, was also consulted.
Evans operation involved excising a large highly vascular multi-cystic and solid tumour that was
deeply enmeshed in the surrounding muscles. It was a highly complex procedure and no easy task.
As it turned out, thanks to the expertise of the multi-disciplinary medical team, Prof Sidler was able

to completely remove Evans coccyx together with the tumour. Evan required highly specialised
nursing care in the hospitals neonatal ICU, but we were delighted with the rapid progress he made,
notes Dr Dippenaar.
We expect Evan to be able to live a completely normal life, although we suspect he may have some
residual functional disability and will require close monitoring to ensure that he does not develop
any further tumours in future, adds Dr Dippenaar.
Dr Dippenaar says that sacrococcygeal teratomas occur in a few different sub-types and are more
common in girls than boys. It has been suggested that this condition is prevalent in some 1 per 27
000 live births. As in Evans case, the tumours are usually benign or non-cancerous, although larger,
immature tumours seem to have a much higher risk of being malignant.
Netcare Blaauwberg hospital manager, Dirk Truter, says that it is comforting to know that the
facility, and indeed the country, can call upon such an outstanding team of neonatal experts to treat
complex and unusual cases. The success of this procedure demonstrates that South African medicine
has world-class expertise in this field, adds Truter.
Baby Evan crept deep into the hearts of the staff at the hospital during his stay. We are grateful to
have been able to make a meaningful difference in Evan and his parents lives and wish them
everything of the best for the future, concludes Truter.
This is the video of Baby Evan's story:
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http://www.health24.com/Parenting/Child/News/Miracle-baby-goes-home-after-highly-specialised-op
eration-to-remove-huge-tumour-20150316