Exomphalos Major Associated with Thoracic Teratoma and Hamartoma of Left Leg: A Rare Association

A 2-day-old, full term (38 weeks), appropriate for gestational age, female baby was delivered vaginally to 22-year-old primigravida at peripheral health facility. The baby did not cry at birth, required positive pressure ventilation for 3 minutes at birth and Apgar score at 1 and 5 minutes after birth were 3/10 and 6/10 respectively. No features of hypoxic ischemic encephalopathy were noticed. The newborn was referred for further investigation and treatment to tertiary health center. There was no history of any drug intake or radiation exposure in mother during antenatal period. On examination, a mass of 4.3 cm × 4 cm × 2.5 cm with two skin appendages was found to be attached to the lower part of the chest wall of the baby (Fig. 1). An exomphalos major and hamartoma of size 3.2 X 3.5 cm in left lower leg was present in the neonate. The liver was protruding into the exomphalos sac that was confirmed on abdominal sonography. Ultrasonography of chest, skull, spine and abdomen, apart from exomphalos were normal. Echocardiography revealed small ventricular septal defect (VSD).