**Figure 5.**

*Large SCT in a newborn—preoperative. SCT represents more than 50% of birthweight, with visible ulceration of the skin.*

**Figure 6.** *Same newborn—postoperative view, after removal of SCT.*

The multiorgan involvement makes the anesthetic management challenging. Prematurity and hypothermia are risk factors for coagulopathy and can lead to fatal consequences. Management of intraoperative bleeding and early extubation are good outcome predictors [5, 13, 14] (**Figure 5**).

Patients with malignant SCT are managed after surgery with irradiation if residual disease is present, and chemotherapy. Most tumors have a plane of dissection and can be removed easily. It is safer and recommended to catheterize the bladder to keep it away from the tumor and place a large rubber catheter in rectum for identification. Levator ani muscles are often stretched over tumor and should be reconstructed after tumor is excised. Drainage is necessary as there is a large raw area and collections should be avoided (**Figure 6**).

Preservation of the autonomous nerve supply to the bladder and rectum may be difficult. Therefore, postoperative complications (31%) that may be expected are bladder dysfunction, incontinence for feces and dysesthesia. The main postoperative early complication is wound infection because of the proximity to the anus and the skin flaps that may be needed.
