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5%) in the perineal area. The association between cutaneous haemangiomas in the lumbosacral area and the underlying developmental anomalies was first reported by Goldberg and Esterly.3 Large perineal haemangiomas may constitute a distinctive group of associated anorectal, neurological, renal or urinary tract and genital defects. Girard et al4 propose the acronym PELVIS syndrome to emphasise the characteristic findings of this syndrome: perineal haemangioma, external genitalia malformations, lipomyelomeningocele, vesicorenal abnormalities, imperforate anus and skin tag. Recently, Stockman et al5 proposed the acronym SACRAL in lumbosacral midline haemangiomas. The acronym stands for: spinal dysraphism, anogenital anomalies, cutaneous anomalies, renal and anomalies associated with an angioma of lumbosacral localisation. Of 49 infants with perineal haemangioma, only 5 (4 male and 1 female) had associated malformations, like anal imperforation, lipomeningocele, subcutaneous lipoma, hypospadias and caudal appendix.5 Embryologically, the perineum is formed by a mesodermal wedge that partitions the cloaca into ventral and dorsal portions giving rise to urogenital and digestive systems. Mesodermal structures also interfere with the development of the lumbosacral areas. The neural groove in the ectoderm of the young embryo separates from the skin ectoderm and is surrounded by mesodermal structures to form the cerebrospinal axis. An abnormal event in some part of this process explains many forms of spinal dysraphism, a term referring to an incomplete fusion or malformation of midline embryonic structures. Bennett et al6 have reviewed the literature regarding the use of oral corticosteroids in cutaneous haemangiomas. This meta-analysis indicates that administration of oral prednisone or prednisolone (2�C3?mg/kg/day) is effective in stabilising or shrinking most cutaneous haemangiomas. In this case, the child was male and had lumbosacral myelomeningocele with slight ulceration and visible haemangiomatous component, absent anal opening with flat bottom, distal penile hypospadias and superficial haemangioma involving the neck, right upper limb and chest wall, upper back, lumbosacral and the perineal area. Learning points A lumbosacral and perineal infantile haemangioma should raise the suspicion of associated genital, anorectal, urinary tract and spinal abnormalities. The acronym SACRAL syndrome may help clinicians to recall the congenital anomalies which may be associated with lumbosacral and perineal haemangiomas. As infantile haemangioma may be absent or subtle at birth, infants with genital, anorectal, urinary or spinal SB431542 chemical structure abnormalities should be watched closely for the development of infantile haemangioma. Complications of untreated tethered cord such as pain, sensory and motor deficits can be eliminated if diagnosed early, monitored appropriately and treated accordingly.