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A baby with a tail
A Baby With By John J White
a Tail
and Howard Baltimore,
R. Wexler,
M.D
Md.
Among the anomalies and curiosities of nature, human tails have been infrequently noted. Apart from an anecdotal resume of reported instances prior to 1937,’ there are only scattered reports in the recent literature. These range from a passing reference in a textbook of Embryology,2 through a few case reports,3*4 to a plea for assistance in the correspondence section of the Journal of the Indian Medical Association.’ A neonate was recently referred with the diagnosis of “an extra penis growing near the anus.” After an uneventful labor and delivery, a 2790-g black boy was noted to have a 4-cm long by l-cm thick fleshy appurtenance attached immediately to the right of his anus (Fig. I). It was covered with skin, had no lumen, was spongy in consistency. and could be retracted and extended. No bone or cartilage could be appreciated. The appendage moved with external anal sphincter contraction or crying. There were no internal masses or connections on rectal examination. and the external genitalia were normal. Roentgenograms of the sacrum showed missing rrght pedicles of the last two vertebrae with deviation to the left. No bone was present in the mass. An IVP was normal. When the appendage was excised. it was found to have a central muscular core which blended with the external anorectal sphincters. Histologic examination demonstrated normal skeletal muscle, connective tissue, and skin (Fig. 2). Although no coccygeal segments were present in this appendage, the abnormalities of the last two sacral segments, coupled with the normal skeletal muscular elements and its site of origin, suggest that this appendage represents a vestigial tail. Jolly3 thought his case represented a “parasitic fetus”; Hamilton and Mossman’ suggested that such tails result from failure of resorption of a primitive embryonic remnant. Whatever the etiology, simple excision appears warranted, particularly when bony elements and neural connections are not present. REFERENCES I. Gould GM, Pyle WL (1896): Anomalies and Curiosities of Medicine (3rd printing). New York, Julian Press. (Original Copyright by W. B. Saunders, 1896) 2. Hamilton WJ. Mossman, HW: Human Embryology (ed 4). Baltimore, Williams & Wilkins, 1972 Fig. 398, p 432
Presented byfore The Fourth .~nnual f’hoenr.t. Aria.. April I.? 14. 1973.
Slrering
Journal of Pediatric Surgery, Vol. 8, No. 5 (October),
3. Jolly H: Baby with a Tail. Arch 38524,
Dis Child
1963
4. Odeku EL, Adeloye A: A case of human pseudo-tail. West Afr Med J 19: I IS, 1970 5. Gaur AC: Correspondence J Indian Med Assoc 52:398. 1969
of The .Amerrcan
1973
Pediarric
Surgical
Is It a Freak?
A.woc,iatiorr,
833
834
CASE
REPORTS
Fig. 1. (A) Posterior view of tail. The 4 cm x l-cm fleshy appendage originates just to the left of the anus, and was attached to the external anorectal sphincters.
Fig. 2. Photomicrograph of tail. Low-power view shows normal striated muscle bundles and connective tissue covered by skin.
a Tail
and Howard Baltimore,
R. Wexler,
M.D
Md.
Among the anomalies and curiosities of nature, human tails have been infrequently noted. Apart from an anecdotal resume of reported instances prior to 1937,’ there are only scattered reports in the recent literature. These range from a passing reference in a textbook of Embryology,2 through a few case reports,3*4 to a plea for assistance in the correspondence section of the Journal of the Indian Medical Association.’ A neonate was recently referred with the diagnosis of “an extra penis growing near the anus.” After an uneventful labor and delivery, a 2790-g black boy was noted to have a 4-cm long by l-cm thick fleshy appurtenance attached immediately to the right of his anus (Fig. I). It was covered with skin, had no lumen, was spongy in consistency. and could be retracted and extended. No bone or cartilage could be appreciated. The appendage moved with external anal sphincter contraction or crying. There were no internal masses or connections on rectal examination. and the external genitalia were normal. Roentgenograms of the sacrum showed missing rrght pedicles of the last two vertebrae with deviation to the left. No bone was present in the mass. An IVP was normal. When the appendage was excised. it was found to have a central muscular core which blended with the external anorectal sphincters. Histologic examination demonstrated normal skeletal muscle, connective tissue, and skin (Fig. 2). Although no coccygeal segments were present in this appendage, the abnormalities of the last two sacral segments, coupled with the normal skeletal muscular elements and its site of origin, suggest that this appendage represents a vestigial tail. Jolly3 thought his case represented a “parasitic fetus”; Hamilton and Mossman’ suggested that such tails result from failure of resorption of a primitive embryonic remnant. Whatever the etiology, simple excision appears warranted, particularly when bony elements and neural connections are not present. REFERENCES I. Gould GM, Pyle WL (1896): Anomalies and Curiosities of Medicine (3rd printing). New York, Julian Press. (Original Copyright by W. B. Saunders, 1896) 2. Hamilton WJ. Mossman, HW: Human Embryology (ed 4). Baltimore, Williams & Wilkins, 1972 Fig. 398, p 432
Presented byfore The Fourth .~nnual f’hoenr.t. Aria.. April I.? 14. 1973.
Slrering
Journal of Pediatric Surgery, Vol. 8, No. 5 (October),
3. Jolly H: Baby with a Tail. Arch 38524,
Dis Child
1963
4. Odeku EL, Adeloye A: A case of human pseudo-tail. West Afr Med J 19: I IS, 1970 5. Gaur AC: Correspondence J Indian Med Assoc 52:398. 1969
of The .Amerrcan
1973
Pediarric
Surgical
Is It a Freak?
A.woc,iatiorr,
833
834
CASE
REPORTS
Fig. 1. (A) Posterior view of tail. The 4 cm x l-cm fleshy appendage originates just to the left of the anus, and was attached to the external anorectal sphincters.
Fig. 2. Photomicrograph of tail. Low-power view shows normal striated muscle bundles and connective tissue covered by skin.