Sacrococcygeal teratoma (SCT) in adults is very rare with only a few cases reported in the literature. Its presentation in the adult is asymptomatic to a slow-growing cystic tumor with a 1-2% chance for malignant transformation and may attain a huge size causing pressure effect on pelvic and intra-abdominal organs. It can present unusually as a perianal abscess which needs to be evaluated radiologically. We present a giant, long-standing SCT in an adult male patient which presented as a tender fluctuating swelling with spontaneous rupture and whitish discharge in the perianal region masquerading as a perianal abscess. Diagnosis of our case was suspected by clinical examination, ultrasound, and magnetic resonance imaging of the pelvis and histopathology confirmed the diagnosis. It was excised en bloc with coccygectomy and primary wound closure and had a good postoperative recovery. Long-standing perianal swelling in an adult should raise the suspicion of SCT and should be kept in the differentials. The author prefers the posterior perineal approach for excision in Altman type 2, as it has convenient control over the mass during surgery with good cosmetic results as in our case, but the role of coccygectomy to prevent recurrence needs long-term data.
