1
|
Narayan R, Meena A, Sarkar R, Agrawal M. A Rare Case Report of Limb Body Wall Complex. Cureus 2024; 16:e59026. [PMID: 38800175 PMCID: PMC11127772 DOI: 10.7759/cureus.59026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Limb body wall complex (LBWC), also known as body stalk anomaly, is a rare and lethal disorder of the anterior abdominal wall. It is characterized by a severe combination of congenital malformations in the fetus, including, abdomino- and/or thoracoschisis, exencephaly/encephalocele, limb deformities, and facial clefts. Short umbilical cord, abdominal placental attachment, and spinal anomalies are among other manifestations of this disorder. The cause of LBWC is still unknown. The main hypotheses include embryonic dysplasia, early amniotic rupture, and vascular accident during embryonic development. We present a case of LBWC that was detected prenatally on ultrasound (USG) imaging and later confirmed postnatally in a Rh-negative mother at the menstrual age of 14 weeks.
Collapse
Affiliation(s)
- Ruchika Narayan
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, IND
| | - Anamika Meena
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, IND
| | - Rajib Sarkar
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, IND
| | - Muskaan Agrawal
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, IND
| |
Collapse
|
2
|
Ye CH, Li S, Ling L. Analysis of characteristic features in ultrasound diagnosis of fetal limb body wall complex during 11-13 +6 weeks. World J Clin Cases 2023; 11:4544-4552. [PMID: 37469738 PMCID: PMC10353514 DOI: 10.12998/wjcc.v11.i19.4544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Limb body wall complex (LBWC) is a fatal malformation characterized by major defects in the fetal abdominal or thoracic wall, visceral herniation, significant scoliosis or spina bifida, limb deformities, craniofacial deformities, and umbilical cord abnormalities (short or absent umbilical cord). Early diagnosis of this condition is of great clinical significance for clinical intervention and pregnancy decision-making. With the rapid development of fetal ultrasound medicine, early pregnancy (11-13+6 wk) standardized prenatal ultrasound examinations have been widely promoted and applied.
AIM To explore the value of prenatal ultrasound in the diagnosis of fetal LBWC syndrome during early pregnancy.
METHODS The ultrasonographic data and follow-up results of 18 cases of fetal LBWC diagnosed by prenatal ultrasound during early pregnancy (11-13+6 wk) were retrospectively analyzed, and their ultrasonographic characteristics were analyzed.
RESULTS Among the 18 fetuses with limb wall abnormalities, there were spinal dysplasia (18/18, 100%), varying degrees of thoracoschisis and gastroschisis (18/18, 100%), limb dysplasia in 6 cases (6/18, 33%), craniocerebral malformations in 4 cases (4/18, 22%), thickening of the transparent layer of the neck in 5 cases (5/18, 28%), and umbilical cord abnormalities in 18 cases (18/18, 100%), single umbilical artery in 5 cases.
CONCLUSION Prenatal ultrasound in early pregnancy can detect LBWC as early as possible, and correct prenatal evaluation provides important guidance value for pregnancy decision-making and early intervention.
Collapse
Affiliation(s)
- Cai-Hong Ye
- Department of Ultrasound, Yijishan Hospital Wannan Medical College, Wuhu 241001, Anhui Province, China
| | - Shuo Li
- Department of Ultrasound, Wannan Medical College, Wuhu 241001, Anhui Province, China
| | - Li Ling
- Department of Obstetrics, Wannan Medical College, Wuhu 241001, Anhui Province, China
| |
Collapse
|
3
|
Țarcă E, Al Namat D, Luca AC, Lupu VV, Al Namat R, Lupu A, Bălănescu L, Bernic J, Butnariu LI, Moscalu M, Hînganu MV. Omphalocele and Cardiac Abnormalities-The Importance of the Association. Diagnostics (Basel) 2023; 13:diagnostics13081413. [PMID: 37189514 DOI: 10.3390/diagnostics13081413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Omphalocele is the most common ventral abdominal wall defect. Omphalocele is associated with other significant anomalies in up to 80% of cases, among which the cardiac ones are the most frequent. The aim of our paper is to highlight, through a review of the literature, the importance and frequency of association between the two malformations and what impact this association has on the management and evolution of patients with these pathologies. We reviewed the titles, the available abstracts, and the full texts of 244 papers from the last 23 years, from three medical databases, to extract data for our review. Due to the frequent association of the two malformations and the unfavorable effect of the major cardiac anomaly on the prognosis of the newborn, the electrocardiogram and echocardiography must be included in the first postnatal investigations. The timing of surgery for abdominal wall defect closure is mostly dictated by the cardiac defect severity, and usually the cardiac defect takes priority. After the cardiac defect is medically stabilized or surgically repaired, the omphalocele reduction and closure of the abdominal defect are performed in a more controlled setting, with improved outcomes. Compared to omphalocele patients without cardiac defects, children with this association are more likely to experience prolonged hospitalizations, neurologic, and cognitive impairments. Major cardiac abnormalities such as structural defects that require surgical treatment or result in developmental delay will significantly increase the death rate of patients with omphalocele. In conclusion, the prenatal diagnosis of omphalocele and early detection of other associated structural or chromosomal anomalies are of overwhelming importance, contributing to the establishment of antenatal and postnatal prognosis.
Collapse
Affiliation(s)
- Elena Țarcă
- Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Dina Al Namat
- "Saint Mary" Emergency Children Hospital, 700309 Iassy, Romania
| | - Alina Costina Luca
- Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Vasile Valeriu Lupu
- Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Razan Al Namat
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Ancuța Lupu
- Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Laura Bălănescu
- Department of Pediatric Surgery and Anaesthesia and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Jana Bernic
- Discipline of Pediatric Surgery, "Nicolae Testemițanu" State University of Medicine and Pharmacy, 2025 Chisinau, Moldova
| | - Lăcrămioara Ionela Butnariu
- Department of Medical Genetics, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Marius Valeriu Hînganu
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| |
Collapse
|
4
|
Bergman JEH, Barišić I, Addor MC, Braz P, Cavero-Carbonell C, Draper ES, Echevarría-González-de-Garibay LJ, Gatt M, Haeusler M, Khoshnood B, Klungsøyr K, Kurinczuk JJ, Latos-Bielenska A, Luyt K, Martin D, Mullaney C, Nelen V, Neville AJ, O'Mahony MT, Perthus I, Pierini A, Randrianaivo H, Rankin J, Rissmann A, Rouget F, Sayers G, Schaub B, Stevens S, Tucker D, Verellen-Dumoulin C, Wiesel A, Gerkes EH, Perraud A, Loane MA, Wellesley D, de Walle HEK. Amniotic band syndrome and limb body wall complex in Europe 1980-2019. Am J Med Genet A 2023; 191:995-1006. [PMID: 36584346 DOI: 10.1002/ajmg.a.63107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
Amniotic band syndrome (ABS) and limb body wall complex (LBWC) have an overlapping phenotype of multiple congenital anomalies and their etiology is unknown. We aimed to determine the prevalence of ABS and LBWC in Europe from 1980 to 2019 and to describe the spectrum of congenital anomalies. In addition, we investigated maternal age and multiple birth as possible risk factors for the occurrence of ABS and LBWC. We used data from the European surveillance of congenital anomalies (EUROCAT) network including data from 30 registries over 1980-2019. We included all pregnancy outcomes, including live births, stillbirths, and terminations of pregnancy for fetal anomalies. ABS and LBWC cases were extracted from the central EUROCAT database using coding information responses from the registries. In total, 866 ABS cases and 451 LBWC cases were included in this study. The mean prevalence was 0.53/10,000 births for ABS and 0.34/10,000 births for LBWC during the 40 years. Prevalence of both ABS and LBWC was lower in the 1980s and higher in the United Kingdom. Limb anomalies and neural tube defects were commonly seen in ABS, whereas in LBWC abdominal and thoracic wall defects and limb anomalies were most prevalent. Twinning was confirmed as a risk factor for both ABS and LBWC. This study includes the largest cohort of ABS and LBWC cases ever reported over a large time period using standardized EUROCAT data. Prevalence, clinical characteristics, and the phenotypic spectrum are described, and twinning is confirmed as a risk factor.
Collapse
Affiliation(s)
- Jorieke E H Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ingeborg Barišić
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Marie-Claude Addor
- Department of Woman-Mother-Child, University Medical Center CHUV, Lausanne, Switzerland
| | - Paula Braz
- RENAC-Registo Nacional de Anomalias Congénitas, Epidemiology Department, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of the Research in Healthcare and Biomedicine, Valencia, Spain
| | | | | | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, G'mangia, Malta
| | - Martin Haeusler
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Babak Khoshnood
- Université de Paris Cité, Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRA, Paris, France
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Latos-Bielenska
- Polish Registry of Congenital Malformations, Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Karen Luyt
- South West Congenital Anomaly Register (SWCAR), Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Carmel Mullaney
- Department of Public Health, HSE South East Area, Dublin, Ireland
| | - Vera Nelen
- Provincial Institute of Hygiene, Antwerp, Belgium
| | - Amanda J Neville
- IMER Registry, Centre for Clinical and Epidemiological Research, University of Ferrara and Azienda Ospedaliero Universitario di Ferrara, Ferrara, Italy
| | - Mary T O'Mahony
- Department of Public Health HSE-South, St Finbarr's Hospital, Cork, Ireland
| | - Isabelle Perthus
- Auvergne Registry of Congenital Anomalies (CEMC-Auvergne), Department of Clinical Genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Hanitra Randrianaivo
- Unit of Genetic Medical and Register of Congenital Malformations, CHU St Pierre La Reunion, Réunion, France
| | - Judith Rankin
- South West Congenital Anomaly Register (SWCAR), Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Florence Rouget
- Brittany Registry of Congenital Anomalies, CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes, France
| | - Gerardine Sayers
- National Health Intelligence Unit, R&D Health Service Executive, Dublin, Ireland
| | - Bruno Schaub
- French West Indies Registry, Registre des Malformations des Antilles (REMALAN), Maison de la Femme de la Mère et de l'Enfant, University Hospital of Martinique, Fort-de-France, France
| | | | - David Tucker
- Congenital Anomaly Register & Information Service for Wales (CARIS), Public Health Wales, Swansea, UK
| | | | - Awi Wiesel
- Births Registry Mainz Model, University of Mainz Medical Center, Mainz, Germany
| | - Erica H Gerkes
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annie Perraud
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Maria A Loane
- Faculty of Life & Health Sciences, Ulster University, Northern Ireland, UK
| | - Diana Wellesley
- Faculty of Medicine and Wessex Clinical Genetics Service, Princess Anne Hospital, University Hospital Southampton, Southampton, UK
| | - Hermien E K de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
5
|
Abstract
Abdominal wall defects are one of the most frequently encountered human congenital anomalies. They are seen in as many as 1 in 2,000 live births with evidence to suggest that their incidence is increasing. While often discussed together abdominal wall defects consist mainly of two entities namely gastroschisis and omphalocele. There are marked differences in their theories of embryo-pathogenesis, clinical presentation/anatomy and overall outcomes. There is no clear consensus explaining the precise embryological mechanisms leading to the development of abdominal wall defects. Many clinicians and embryologists have attempted to explain the genesis of congenital abdominal wall defects because of failure of progression of various phases of normal embryonic development. This review summarizes the mechanisms involved in normal and abnormal development of the ventral abdominal wall leading to the development of gastroschisis and omphalocele.
Collapse
|
6
|
Isolated thoracoschisis: Case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
7
|
Haddout S, Ikouch K, Jalal M, Lamrissi A, Bouhya S. A rare case of limb body wall complex. Radiol Case Rep 2022; 17:4013-4017. [PMID: 36039086 PMCID: PMC9418206 DOI: 10.1016/j.radcr.2022.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/29/2022] Open
Abstract
Limb body wall complex (LBWC) is a complex and rare poly-malformative syndrome. We report a case of this syndrome diagnosed antenatally in a 37-year-old primiparous woman, by a first obstetrical ultrasound performed at 22 weeks of amenorrhea and one day. After termination of pregnancy, macroscopic examination revealed a male newborn with all the diagnostic criteria of LBWC.
Collapse
Affiliation(s)
- S. Haddout
- Obstetrics Department, Children's hospital El Harrouch, University Hospital of Casablanca, Casablanca, Morocco
- Corresponding author.
| | - K. Ikouch
- Obstetrics Department, Children's hospital El Harrouch, University Hospital of Casablanca, Casablanca, Morocco
| | - M. Jalal
- Faculty of Medicine and Pharmacy of Casablanca, Casablanca, Morocco
| | - A. Lamrissi
- Faculty of Medicine and Pharmacy of Casablanca, Casablanca, Morocco
| | - S. Bouhya
- Hassan II University, Casablanca, Morocco
| |
Collapse
|
8
|
Adeleke O, Gill F, Krishnan R. Rare Presentation of Limb-Body Wall Complex in a Neonate: Case Report and Review of Literature. AJP Rep 2022; 12:e108-e112. [PMID: 35265395 PMCID: PMC8916848 DOI: 10.1055/s-0042-1744215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/20/2021] [Indexed: 10/18/2022] Open
Abstract
The limb-body wall complex (LBWC) aka body stalk syndrome is an uncommon congenital disorder characterized by severe malformations of limb, thorax, and abdomen, characterized by the presence of thoracoschisis, abdominoschisis, limb defects, and exencephaly. This condition is extremely rare with an incidence of 1 per 14,000 and 1 per 31,000 pregnancies in large epidemiologic studies. Majority of these malformed fetuses end up with spontaneous abortions. We present this rare case with occurrence in a preterm infant of 35 weeks' gestation. Our report highlights majority of the clinical presentations as reported in previous literature, but the significant pathological findings of absent genitalia and malformed genitourinary as well as anorectal malformations make this case presentation an even more rare occurrence. Infant karyotyping was normal male and there is no specific underlying genetic correlation in this condition which has a fatal prognosis.
Collapse
Affiliation(s)
- Omoloro Adeleke
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Farrukh Gill
- Department of Pathology, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ramesh Krishnan
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| |
Collapse
|
9
|
Kawaguchi K, Obayashi J, Koike J, Tanaka K, Seki Y, Nagae H, Ohyama K, Furuta S, Valsenti G, Pringle KC, Kitagawa H. Muscle imbalance as a cause of scoliosis: a study in a fetal lamb abdominal wall defect model. Pediatr Surg Int 2021; 37:1755-1760. [PMID: 34510262 DOI: 10.1007/s00383-021-05000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We created abdominal wall defects (AWD) in fetal lambs to investigate possible causes of scoliosis. METHODS We incised the upper abdominal wall (including Rectus) in 60-day gestation fetal lambs, from the midline to either the right (Group A) or left (Group B) costal margin, in 14 lambs carried by 7 ewes. They were delivered by cesarean section at term (about 145 days). Scoliosis was evaluated by anterio-posterior X-rays, determining the Cobb angle. RESULTS Four fetuses in Group A and 3 in Group B survived. There were 3 successful AWD lambs Group A and 2 in Group B. One lamb in each group survived with the AWD covered with a thick capsule. The convexity of spinal curve was the direction of scoliosis. Right scoliosis was only seen in the 4 Group A lambs. Left scoliosis was only seen in Group B lambs (2/3, 67%). The mean Cobb angle was 41.7 ± 11.5° in Group A and in Group B the Cobb angles were 59.6o and 60.6°. Overall, 4/5 lambs with organ prolapse (80%) and both lambs without organ prolapse had scoliosis. CONCLUSION Muscle imbalance may contribute to the development of scoliosis in a fetal lamb AWD model.
Collapse
Affiliation(s)
- Kohei Kawaguchi
- Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand
| | - Juma Obayashi
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Junki Koike
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kunihide Tanaka
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Yasuji Seki
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Hideki Nagae
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Kei Ohyama
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Shigeyuki Furuta
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Gianluca Valsenti
- Department of Radiology, Capital & Coast DHB, Wellington, New Zealand
| | - Kevin C Pringle
- Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand
| | - Hiroaki Kitagawa
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.
| |
Collapse
|
10
|
Ragan M, Mathur K, Hartwich J. A novel surgical approach to thoracoschisis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
11
|
Raitio A, Tauriainen A, Leinonen MK, Syvänen J, Kemppainen T, Löyttyniemi E, Sankilampi U, Gissler M, Hyvärinen A, Helenius I. Extended spectrum penicillins reduce the risk of omphalocele: A population-based case-control study. J Pediatr Surg 2021; 56:1590-1595. [PMID: 33250216 DOI: 10.1016/j.jpedsurg.2020.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/29/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Omphalocele is a major congenital anomaly associated with significant morbidity and mortality. Regardless, the influence of maternal use of prescription drugs on the risk of omphalocele has only been addressed in a handful of studies. The aim of this study was to assess the influence of maternal risk factors and prescription drugs in early pregnancy on the risk of omphalocele. METHODS We performed a nationwide register-based case-control study in Finland. The analysis is based on the Finnish Register of Congenital Malformations and Drugs and Pregnancy databases, both upheld by the Finnish Institute for Health and Welfare. All omphalocele cases were identified between Jan 1, 2004, and Dec 31, 2014. Five age-matched controls from the same geographical region were randomly selected for each case. The main outcome measures were maternal risk factors for omphalocele. Our analysis compared the maternal characteristics and the use of prescription drugs during the first trimester of pregnancy between case and control mothers. RESULTS Mothers of 359 omphalocele cases were compared with 1738 randomly selected age and area-matched mothers of healthy infants between 1 January 2014 and 31 December 2014. Both maternal obesity (BMI ≥30) and diabetes increased the risk for omphalocele, and their co-occurrence accumulated this risk (aOR 5.06, 95% Cl 1.19-21.4). Similarly, history of multiple miscarriages was an independent risk factor (2.51, 1.16-5.43). The oral use of extended spectrum penicillins during the first trimester of pregnancy had a significant, protective influence (0.17, 0.04-0.71). These analyses were adjusted for sex, parity, and risk factors reported above. No significant changes in risk were observed with any other medication used during the first trimester. CONCLUSION In conclusion, these findings may suggest that extended spectrum penicillins in the first trimester reduces the risk of omphalocle formation. Additionally, consistent with earlier studies, previous repeated miscarriages, maternal obesity, and diabetes were significant risk factors for omphalocele.
Collapse
Affiliation(s)
- Arimatias Raitio
- Department of Paediatric Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, 20521, Turku, Finland.
| | - Asta Tauriainen
- Department of Paediatric Surgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Maarit K Leinonen
- Information Services Department, Finnish Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271 Helsinki, Finland
| | - Johanna Syvänen
- Department of Paediatric Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, 20521, Turku, Finland
| | - Teemu Kemppainen
- Department of Biostatistics, University of Turku and Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku and Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Ulla Sankilampi
- Department of Paediatrics, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271 Helsinki, Finland; Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Solnavägen 1, 17177, Solna, Sweden
| | - Anna Hyvärinen
- Department of Paediatric Surgery, Tampere University Hospital and Tampere University, Elämänaukio, Kuntokatu 2, 33520, Tampere, Finland
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Finland
| |
Collapse
|
12
|
Kashyap R, Devaraj SK, Chakkalakkoombil SV, Mohan SL. Limb body wall complex complicating a dichorionic diamniotic twin pregnancy: MRI for demonstration of fetal morphology. BMJ Case Rep 2021; 14:14/5/e242783. [PMID: 33980568 PMCID: PMC8118015 DOI: 10.1136/bcr-2021-242783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Limb body wall complex (LBWC) is a rare, lethal malformation characterised by body wall defects, craniofacial and limb anomalies with or without various other organ anomalies. We report a case of dichorionic diamniotic twin pregnancy discordant for LBWC, diagnosed by ultrasound (US) and confirmed by MRI at 21 weeks' gestation, managed expectantly and delivered at 35 weeks by emergency caesarean section with a favourable outcome of the unaffected twin. The anomalous twin, who died soon after birth, had a sizeable thoracoabdominal wall defect, eviscerated liver and bowel loops attached to the placenta, short cord, ectopia cordis, lung hypoplasia, kyphoscoliosis, right upper limb amelia and left clubfoot with polydactyly. MRI helps to demonstrate the fetal morphology better when there are limitations to the US due to unfavourable fetal position, multifetal gestation, maternal obesity or reduced liquor. In twin pregnancies, the management will depend on ensuring the survival of the unaffected twin.
Collapse
Affiliation(s)
- Ravindar Kashyap
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Pondicherry, India
| | - Sunil Kumar Devaraj
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Pondicherry, India
| | | | - Supraja Laguduva Mohan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Pondicherry, India
| |
Collapse
|
13
|
Ginzel M, Martynov I, Haak R, Lacher M, Kluth D. Midgut development in rat embryos using microcomputed tomography. Commun Biol 2021; 4:190. [PMID: 33580156 PMCID: PMC7881192 DOI: 10.1038/s42003-021-01702-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/05/2021] [Indexed: 11/08/2022] Open
Abstract
The development of the mammalian gut was first described more than a century ago. Since then, it has been believed that a series of highly orchestrated developmental processes occur before the intestine achieves its final formation. The key steps include the formation of the umbilicus, the so-called "physiological herniation" of the midgut into the umbilical cord, an intestinal "rotation", and the "return of the gut" into the abdominal cavity. However, this sequence of events is predominantly based on histological sections of dissected embryos, a 2D technique with methodological limitations. For a better understanding of spatial relationships in the embryo, we utilized microcomputed tomography (µCT), a nondestructive 3D imaging method. Here, we show the detailed processes and mechanisms of intestinal development in rat embryos, including the development of the umbilicus, the formation of loops inside the umbilical coelom, and the subsequent shift of these loops into the abdominal cavity. Our 3D datasets of developing intestines will substantially advance the understanding of normal mammalian midgut embryology and offer new possibilities to reveal unknown mechanisms in the pathogenesis of congenital disorders.
Collapse
Affiliation(s)
- Marco Ginzel
- Department of Neonatology, University Children's Hospital Tuebingen, Tuebingen, Germany.
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany.
| | - Illya Martynov
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Dietrich Kluth
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| |
Collapse
|
14
|
Stevenson RE. Common pathogenesis for sirenomelia, OEIS complex, limb-body wall defect, and other malformations of caudal structures. Am J Med Genet A 2021; 185:1379-1387. [PMID: 33522143 DOI: 10.1002/ajmg.a.62103] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/11/2023]
Abstract
Decades of clinical, pathological, and epidemiological study and the recent application of advanced microarray and gene sequencing technologies have led to an understanding of the causes and pathogenesis of most recognized patterns of malformation. Still, there remain a number of patterns of malformation whose pathogenesis has not been established. Six such patterns of malformation are sirenomelia, VACTERL association, OEIS complex, limb-body wall defect (LBWD), urorectal septum malformation (URSM) sequence, and MURCS association, all of which predominantly affect caudal structures. On the basis of the overlap of the component malformations, the co-occurrence in individual fetuses, and the findings on fetal examination, a common pathogenesis is proposed for these patterns of malformation. The presence of a single artery in the umbilical cord provides a visible clue to the pathogenesis of all cases of sirenomelia and 30%-50% of cases of VACTERL association, OEIS complex, URSM sequence, and LBWD. The single artery is formed by a coalescence of arteries that supply the yolk sac, arises from the descending aorta high in the abdominal cavity, and redirects blood flow from the developing caudal structures of the embryo to the placenta. This phenomenon during embryogenesis is termed vitelline vascular steal.
Collapse
Affiliation(s)
- Roger E Stevenson
- Greenwood Genetic Center, J. C. Self Research Institute of Human Genetics, Greenwood, South Carolina, USA
| |
Collapse
|
15
|
Body stalk anomaly presenting as an emergency in Ethiopia: a case report. J Med Case Rep 2020; 14:205. [PMID: 33115503 PMCID: PMC7594289 DOI: 10.1186/s13256-020-02509-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Body stalk anomaly is a generally lethal malformation of the thorax and/or abdomen. It is often associated with limb defects. The intrathoracic and abdominal organs lie outside the abdominal cavity. These are contained within a sac composed of amnioperitoneal membrane attached directly to the placenta. The umbilical cord may be totally absent or extremely shortened. Severe kyphoscoliosis is often present. This case is reported to highlight this rare malformation and its clinical presentation. CASE PRESENTATION We present a case of a 27-year-old primigravida Oromo woman who had been amenorrheic for 9 months. She presented with an urge to bear down of 10 hours and passage of liquor of the same duration. The patient was referred from a district primary hospital with a diagnosis of preterm labor and hand prolapse. A lower uterine segment cesarean section was performed at Jimma University Medical Center for an indication of active first stage of labor with nonreassuring fetal heart rate pattern (fetal bradycardia) and hand prolapse to effect an anomalous fetus that had only a rudimentary right lower extremity and liver and intestine found outside the abdominal cavity contained within a sac composed of transparent membrane attached directly to the placenta. The umbilical cord was very short, measuring about 7 cm. The fetus had severe scoliosis. It also had a heartbeat upon extraction, which stopped after 5 minutes of delivery. The placenta and fetal body parts together weighed 2400 g. CONCLUSION Termination of pregnancy is usually offered because this abnormality is generally considered lethal. If the pregnancy is continued undetected as in our patient's case, vaginal delivery is recommended, given the highly lethal nature of this anomaly. Good prenatal screening and counseling are recommended for early detection and management.
Collapse
|
16
|
Martín-Alguacil N. Anatomy-based diagnostic criteria for complex body wall anomalies (CBWA). Mol Genet Genomic Med 2020; 8:e1465. [PMID: 32856427 PMCID: PMC7549580 DOI: 10.1002/mgg3.1465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/11/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Precise diagnosis and classification of CBWA cases can be challenging. BSA are considered when there is a body wall anomaly, skeletal abnormalities, and the umbilical cord is anomalous, absent or rudimentary, and LBWC when there is a body wall and structural limb anomalies with or without craniofacial abnormalities. METHODS PubMed was searched for body stalk anomalies, limb body wall complex, body stalk anomalies and amniotic band syndrome, and limb body wall complex and amniotic band syndrome. Sixty nine articles were selected and reviewed. This article systematically classifies the variants of CBWA in 218 cases, the study is based on the embryological and anatomical criteria established by Martín-Alguacil and Avedillo to study BSA in the pig. RESULTS Eight different BSA presentation were defined. One hundred and eighty nine cases were classified as BSA, from which five were Type I, nine Type II, 20 Type III, 57 Type IV, 11Type V, 24 Type VI, 11 Type VII, and 52 Type VIII. Twenty six cases presented cranial phenotype, 114 abdominal phenotype, 42 cranio/abdominal overlapping phenotype, and five without defined phenotype. In addition, 52 BSA cases presented some kind of spinal dysraphism (SPDYS) and were classified as BSA/SPDYS, most of these cases did not show structural limb anomalies, except for three cases and were classified as LBWC/SPDYS. CONCLUSION This morphology-based classification represents a useful tool for clinical diagnosis, it helps to quantify and to evaluate CBWA in a precise, objective manner.
Collapse
|
17
|
Souza MR, Ibelli AMG, Savoldi IR, Cantão ME, Peixoto JDO, Mores MAZ, Lopes JS, Coutinho LL, Ledur MC. Transcriptome analysis identifies genes involved with the development of umbilical hernias in pigs. PLoS One 2020; 15:e0232542. [PMID: 32379844 PMCID: PMC7205231 DOI: 10.1371/journal.pone.0232542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/16/2020] [Indexed: 02/06/2023] Open
Abstract
Umbilical hernia (UH) is one of the most frequent defects affecting pig production, however, it also affects humans and other mammals. UH is characterized as an abnormal protrusion of the abdominal contents to the umbilical region, causing pain, discomfort and reduced performance in pigs. Some genomic regions associated to UH have already been identified, however, no study involving RNA sequencing was performed when umbilical tissue is considered. Therefore, here, we have sequenced the umbilical ring transcriptome of five normal and five UH-affected pigs to uncover genes and pathways involved with UH development. A total of 13,216 transcripts were expressed in the umbilical ring tissue. From those, 230 genes were differentially expressed (DE) between normal and UH-affected pigs (FDR <0.05), being 145 downregulated and 85 upregulated in the affected compared to the normal pigs. A total of 68 significant biological processes were identified and the most relevant were extracellular matrix, immune system, anatomical development, cell adhesion, membrane components, receptor activation, calcium binding and immune synapse. The results pointed out ACAN, MMPs, COLs, EPYC, VIT, CCBE1 and LGALS3 as strong candidates to trigger umbilical hernias in pigs since they act in the extracellular matrix remodeling and in the production, integrity and resistance of the collagen. We have generated the first transcriptome of the pig umbilical ring tissue, which allowed the identification of genes that had not yet been related to umbilical hernias in pigs. Nevertheless, further studies are needed to identify the causal mutations, SNPs and CNVs in these genes to improve our understanding of the mechanisms of gene regulation.
Collapse
Affiliation(s)
- Mayla Regina Souza
- Programa de Pós-graduação em Zootecnia, Centro de Educação Superior do Oeste, Universidade do Estado de Santa Catarina, UDESC, Chapecó, Santa Catarina, Brazil
| | | | - Igor Ricardo Savoldi
- Programa de Pós-graduação em Zootecnia, Centro de Educação Superior do Oeste, Universidade do Estado de Santa Catarina, UDESC, Chapecó, Santa Catarina, Brazil
| | | | | | | | | | - Luiz Lehmann Coutinho
- Laboratório de Biotecnologia Animal, Escola Superior de Agricultura “Luiz de Queiroz”, Universidade de São Paulo, Piracicaba, São Paulo, Brazil
| | - Mônica Corrêa Ledur
- Programa de Pós-graduação em Zootecnia, Centro de Educação Superior do Oeste, Universidade do Estado de Santa Catarina, UDESC, Chapecó, Santa Catarina, Brazil
- Embrapa Suínos e Aves, Concórdia, Santa Catarina, Brazil
| |
Collapse
|
18
|
Body Wall Defects: Gastroschisis and Omphalocoele in Pigs (Sus scrofa domesticus). J Comp Pathol 2020; 175:69-74. [PMID: 32138845 DOI: 10.1016/j.jcpa.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 01/29/2023]
Abstract
Body wall defects (BWDs) are not well studied and categorized in veterinary medicine. BWDs can be an isolated occurrence, but often occur with other major developmental abnormalities. Thirty-two body wall malformations of domestic pigs (Sus scrofa domesticus) are presented and classified, distinguishing between body wall dysplasia (umbilical hernia, abdominal wall distension and gastroschisis), omphalocoele and thoracoabdominoschisis (Cantrell syndrome, shistosomus reflexus, body stalk anomalies).
Collapse
|
19
|
Bioinformatic Analysis of Gene Variants from Gastroschisis Recurrence Identifies Multiple Novel Pathogenetic Pathways: Implication for the Closure of the Ventral Body Wall. Int J Mol Sci 2019; 20:ijms20092295. [PMID: 31075877 PMCID: PMC6539040 DOI: 10.3390/ijms20092295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 01/08/2023] Open
Abstract
We investigated whether likely pathogenic variants co-segregating with gastroschisis through a family-based approach using bioinformatic analyses were implicated in body wall closure. Gene Ontology (GO)/Panther functional enrichment and protein-protein interaction analysis by String identified several biological networks of highly connected genes in UGT1A3, UGT1A4, UGT1A5, UGT1A6, UGT1A7, UGT1A8, UGT1A9, UGT1A10, AOX1, NOTCH1, HIST1H2BB, RPS3, THBS1, ADCY9, and FGFR4. SVS–PhoRank identified a dominant model in OR10G4 (also as heterozygous de novo), ITIH3, PLEKHG4B, SLC9A3, ITGA2, AOX1, and ALPP, including a recessive model in UGT1A7, UGT1A6, PER2, PTPRD, and UGT1A3. A heterozygous compound model was observed in CDYL, KDM5A, RASGRP1, MYBPC2, PDE4DIP, F5, OBSCN, and UGT1A. These genes were implicated in pathogenetic pathways involving the following GO related categories: xenobiotic, regulation of metabolic process, regulation of cell adhesion, regulation of gene expression, inflammatory response, regulation of vascular development, keratinization, left-right symmetry, epigenetic, ubiquitination, and regulation of protein synthesis. Multiple background modifiers interacting with disease-relevant pathways may regulate gastroschisis susceptibility. Based in our findings and considering the plausibility of the biological pattern of mechanisms and gene network modeling, we suggest that the gastroschisis developmental process may be the consequence of several well-orchestrated biological and molecular mechanisms which could be interacting with gastroschisis predispositions within the first ten weeks of development.
Collapse
|
20
|
Abstract
Congenital abdominal wall defects are one of the most common human birth defects with an incidence of about 1 in 2000 live births. While often discussed together abdominal wall defects consist mainly of two distinct entities namely gastroschisis and omphalocele. There is no clear consensus explaining the precise embryological mechanisms leading to the development of an omphalocele. Many clinicians and embryologists have attempted to explain congenital malformation as a result of failure of progression of normal embryonic development. This review summarizes the mechanisms involved in normal and abnormal development of the ventral abdominal wall.
Collapse
Affiliation(s)
- Faraz A Khan
- Division of Pediatric Surgery, Loma Linda University College of Medicine, Loma Linda, CA USA
| | - Asra Hashmi
- Division of Plastic Surgery, Loma Linda University College of Medicine, Loma Linda, CA USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Rd. P.O. Box 10019, Gainesville, FL USA.
| |
Collapse
|
21
|
Coleman PW, Marine MB, Weida JN, Gray BW, Billmire DF, Brown BP. Fetal MRI in the Identification of a Fetal Ventral Wall Defect Spectrum. AJP Rep 2018; 8:e264-e276. [PMID: 30377551 PMCID: PMC6205859 DOI: 10.1055/s-0038-1675353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To ascertain if useful criteria for prenatal diagnosis of fetal ventral body wall defects (VBWDs) exists by reviewing published literature on diagnosis of VBWD as compared with our own diagnostic experience. Study Design A comprehensive literature review of diagnostic criteria of fetal VBWD including pentalogy of Cantrell (POC), omphalocele, exstrophy, imperforate anus, spina bifida (OEIS), cloacal exstrophy, limb-body wall complex (LBWC), and body stalk anomaly was performed followed by a retrospective review of all fetal magnetic resonance imaging (MRI) examinations from our medical center over a 2-year period. Results Classically, OEIS is omphalocele, bladder exstrophy, imperforate anus, and spina bifida. POC is defects of the supraumbilical abdomen, sternum, diaphragm, pericardium, and heart. LBWC is two of the following: exencephaly or enencephaly with facial clefts, thoracoschisis or abdominoschisis, and limb defects. Twenty-four cases of VBWD on MRI over a 24-month period were identified with seven cases involving defects of additional organ systems. Six of these seven cases demonstrated findings from two or more of the traditional diagnoses POC, OEIS, and LBWC making diagnosis and counseling difficult. Conclusion There is a lack of consensus on useful diagnostic criteria within the published literature which is reflected in our own diagnostic experience and poses a challenge for accurate prenatal counseling.
Collapse
Affiliation(s)
- Peter W Coleman
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Megan B Marine
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jennifer N Weida
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brian W Gray
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Deborah F Billmire
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brandon P Brown
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
22
|
Holmes LB, Westgate MN, Nasri H, Toufaily MH. Malformations attributed to the process of vascular disruption. Birth Defects Res 2018; 110:98-107. [DOI: 10.1002/bdr2.1160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/03/2017] [Accepted: 10/22/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Lewis B. Holmes
- Department of Pediatric Newborn Medicine; Brigham and Women's Hospital; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children; Boston Massachusetts
- Department of Pediatrics; Harvard Medical School; Boston Massachusetts
| | - Marie-Noel Westgate
- Department of Pediatric Newborn Medicine; Brigham and Women's Hospital; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children; Boston Massachusetts
| | - Hanah Nasri
- Department of Pediatric Newborn Medicine; Brigham and Women's Hospital; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children; Boston Massachusetts
| | - M. Hassan Toufaily
- Department of Pediatric Newborn Medicine; Brigham and Women's Hospital; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children; Boston Massachusetts
| |
Collapse
|
23
|
Alvarez de la Rosa Rodríguez M, Padilla-Pérez AI, Mastrolia SA, Martínez-Wallin I, Carballo-Lorenzo J, Troyano-Luque JM. Discordant malformation in a monozygotic pregnancy: abdominoschisis and sirenomelia. CASE REPORTS IN PERINATAL MEDICINE 2017. [DOI: 10.1515/crpm-2016-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Congenital malformations occur in up to 10% of monochorionic twins and are usually discordant. Body wall defect (BWD) is a rare entity of very low prevalence, defined as a combination of various malformations, including fetal body mutilations of thoracic and/or abdominal organs that can be caused by amniotic rupture early in embryonic development. Sirenomelia is a form of caudal regression syndrome that presents with lower limb fusion, among other anomalies. In this report, we will present a second trimester monochorionic diamniotic pregnancy, with BWD-abdominoschisis in one fetus and sirenomelia in the other one. Amniotic bands could not be found. Of particular importance in respect to both malformations is the timing of the insult that could have caused both anomalies.
Collapse
Affiliation(s)
- Margarita Alvarez de la Rosa Rodríguez
- Department of Obstetrics and Gynecology, Ultrasound and Fetal Medicine Unit , Hospital Universitario de Canarias, Universidad de La Laguna , Ofra, Santa Cruz de Tenerife , 38320 Spain
| | - Ana Isabel Padilla-Pérez
- Department of Obstetrics and Gynecology, Ultrasound and Fetal Medicine Unit , Hospital Universitario de Canarias, Universidad de La Laguna , Ofra, Santa Cruz de Tenerife , 38320 Spain
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, School of Medicine , University Hospital Policlinico of Bari and University of Bari “Aldo Moro” , Piazza Giulio Cesare 11 , 70124 Bari , Italy
| | - Ingrid Martínez-Wallin
- Department of Obstetrics and Gynecology, Ultrasound and Fetal Medicine Unit , Hospital Universitario de Canarias, Universidad de La Laguna , Ofra, Santa Cruz de Tenerife , 38320 Spain
| | - Janet Carballo-Lorenzo
- Department of Obstetrics and Gynecology, Ultrasound and Fetal Medicine Unit , Hospital Universitario de Canarias, Universidad de La Laguna , Ofra, Santa Cruz de Tenerife , 38320 Spain
| | - Juan Mario Troyano-Luque
- Department of Obstetrics and Gynecology, Ultrasound and Fetal Medicine Unit , Hospital Universitario de Canarias, Universidad de La Laguna , Ofra, Santa Cruz de Tenerife , 38320 Spain
| |
Collapse
|
24
|
Role of Ultrasound in Body Stalk Anomaly and Amniotic Band Syndrome. Int J Reprod Med 2016; 2016:3974139. [PMID: 27699204 PMCID: PMC5027049 DOI: 10.1155/2016/3974139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 11/17/2022] Open
Abstract
Body stalk anomaly (BSA) and amniotic band syndrome (ABS) are rare similar fetal sporadic polymalformative syndromes of unknown etiology, though there are certain differences between them. BSA is a combination of developmental abnormalities involving neural tube, body wall, and the limbs with persistent extra embryonic coelomic cavity. ABS is characterized by the presence of thin membrane-like strands attached to fetal body parts and causing constrictions and amputations. This is a cohort study involving 32,100 patients who were referred for routine antenatal ultrasound scan. The data was entered prospectively into a computer database. The duration of study was 3 years. In our study, ultrasound examination in 86 patients demonstrated ventral wall defects, craniofacial defects, and spinal and limb deformities as isolated or combined abnormalities. In those, 10 patients were suspected/diagnosed as BSA/ABS including a twin of a dichorionic diamniotic gestation. The typical features of body stalk anomaly can be detected by ultrasound by the end of the first trimester, which is important for the patient counselling and management. We are presenting these rare conditions and highlighting the importance of early sonographic imaging in diagnosing and differentiating them from other anterior abdominal wall defects.
Collapse
|
25
|
Bhat A, Ilyas M, Dev G. Prenatal sonographic diagnosis of limb-body wall complex: case series of a rare congenital anomaly. Radiol Case Rep 2016; 11:116-20. [PMID: 27257465 PMCID: PMC4878923 DOI: 10.1016/j.radcr.2016.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 02/07/2016] [Indexed: 12/01/2022] Open
Abstract
Three case reports of a rare congenital anomaly “limb-body wall complex” also known as “body stalk syndrome” are presented with prenatal ultrasonographic diagnostic features, immediate after delivery evaluation, and histopathologic analysis.
Collapse
Affiliation(s)
- Arshad Bhat
- Department of Radiodiagnosis and Imaging, SMGS Hospital, Govt. Medical College and Associated Hospitals, Jammu, 180001, India
| | - Mohd Ilyas
- Department of Radiodiagnosis and Imaging, Govt. Medical College and Associated Hospitals, Jammu, Lane 22, House No. 38, Tawi Vihar, Sidhra, Jammu, 180001, India
| | - Ghanshyam Dev
- Department of Radiodiagnosis and Imaging, Govt. Medical College and Associated Hospitals, Jammu, Lane 22, House No. 38, Tawi Vihar, Sidhra, Jammu, 180001, India
| |
Collapse
|
26
|
Maarse W, Boonacker CWB, Breugem CC, Kon M, Manten GTR, Mink van der Molen AB. A practical prenatal ultrasound classification system for common oral clefts. Prenat Diagn 2015; 35:894-900. [DOI: 10.1002/pd.4631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Wiesje Maarse
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - Chantal W. B. Boonacker
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht the Netherlands
| | - Corstiaan C. Breugem
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - Moshe Kon
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - Gwendolyn T. R. Manten
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| | - Aebele B. Mink van der Molen
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht the Netherlands
| |
Collapse
|
27
|
Kruszka P, Uwineza A, Mutesa L, Martinez AF, Abe Y, Zackai EH, Ganetzky R, Chung B, Stevenson RE, Adelstein RS, Ma X, Mullikin JC, Hong SK, Muenke M. Limb body wall complex, amniotic band sequence, or new syndrome caused by mutation in IQ Motif containing K (IQCK)? Mol Genet Genomic Med 2015; 3:424-32. [PMID: 26436108 PMCID: PMC4585450 DOI: 10.1002/mgg3.153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/30/2015] [Accepted: 04/07/2015] [Indexed: 12/31/2022] Open
Abstract
Limb body wall complex (LBWC) and amniotic band sequence (ABS) are multiple congenital anomaly conditions with craniofacial, limb, and ventral wall defects. LBWC and ABS are considered separate entities by some, and a continuum of severity of the same condition by others. The etiology of LBWC/ABS remains unknown and multiple hypotheses have been proposed. One individual with features of LBWC and his unaffected parents were whole exome sequenced and Sanger sequenced as confirmation of the mutation. Functional studies were conducted using morpholino knockdown studies followed by human mRNA rescue experiments. Using whole exome sequencing, a de novo heterozygous mutation was found in the gene IQCK: c.667C>G; p.Q223E and confirmed by Sanger sequencing in an individual with LBWC. Morpholino knockdown of iqck mRNA in the zebrafish showed ventral defects including failure of ventral fin to develop and cardiac edema. Human wild-type IQCK mRNA rescued the zebrafish phenotype, whereas human p.Q223E IQCK mRNA did not, but worsened the phenotype of the morpholino knockdown zebrafish. This study supports a genetic etiology for LBWC/ABS, or potentially a new syndrome.
Collapse
Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Annette Uwineza
- Center for Medical Genetics, College of Medicine and Health Sciences, University of Rwanda Huye, Rwanda
| | - Leon Mutesa
- Center for Medical Genetics, College of Medicine and Health Sciences, University of Rwanda Huye, Rwanda
| | - Ariel F Martinez
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Yu Abe
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Elaine H Zackai
- Division of Human Genetics, The Children's Hospital of Philadelphia, Clinical Genetics Center, Perelman School of Medicine of the University of Pennsylvania Philadelphia, Pennsylvania
| | - Rebecca Ganetzky
- Division of Human Genetics, The Children's Hospital of Philadelphia, Clinical Genetics Center, Perelman School of Medicine of the University of Pennsylvania Philadelphia, Pennsylvania
| | - Brian Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong Pokfulam, Hong Kong
| | | | - Robert S Adelstein
- Laboratory of Molecular Cardiology, National Heart Lung and Blood Institute, National Institutes of Health Bethesda, Maryland
| | - Xuefei Ma
- Laboratory of Molecular Cardiology, National Heart Lung and Blood Institute, National Institutes of Health Bethesda, Maryland
| | - James C Mullikin
- Comparative Genomics Analysis Unit, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Sung-Kook Hong
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| |
Collapse
|
28
|
Kocherla K, Kumari V, Kocherla PR. Prenatal diagnosis of body stalk complex: A rare entity and review of literature. Indian J Radiol Imaging 2015; 25:67-70. [PMID: 25709170 PMCID: PMC4329692 DOI: 10.4103/0971-3026.150162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Body stalk anomalies are a group of massively disfiguring abdominal wall defects in which the abdominal organs lie outside of the abdominal cavity in a sac of amnioperitoneum with absence of or very small umbilical cord. Various hypotheses proposed to explain the pathogenesis of limb body wall complex include early amnion disruptions, embryonic dysplasia, and vascular disruption in early pregnancy. Body stalk anomaly is an accepted fatal anomaly and, hence, its early diagnosis aids in proper management of the patient.
Collapse
|
29
|
Abstract
Limb body wall complex (LBWC) is characterized by multiple severe congenital malformations including an abdominal and/or thoracic wall defect covered by amnion, a short or absent umbilical cord with the placenta almost attached to the anterior fetal wall, intestinal malrotation, scoliosis, and lower extremity anomalies. There is no consensus about the etiology of LBWC and many cases with abnormal facial cleft do not meet the requirements for the true complex. We describe a series of four patients with LBWC and other malformations in an attempt to explain their etiology. There are several reports of fetuses with LBWC and absent gallbladder and one of our patients also had polysplenia. Absent gallbladder and polysplenia are associated with laterality genes including HOX, bFGF, transforming growth factor beta/activins/BMP4, WNT 1-8, and SHH. We postulate that this severe malformation may be due to abnormal genes involved in laterality and caudal development.
Collapse
Affiliation(s)
- David C Gajzer
- Department of Pathology, University of Miami, Holtz Children's Hospital , Miami, Florida , USA
| | | | | | | | | |
Collapse
|
30
|
Rodríguez González ZI, Soriano Padilla F. [Complex of amniotic deformities, adhesions, mutilations: Endless debate]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:159-168. [PMID: 29421497 DOI: 10.1016/j.bmhimx.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 11/28/2022] Open
Abstract
Amniotic deformities, adhesions, mutilations (ADAM) complex is a broad heterogeneous spectrum of congenital anomalies. ADAM complex is characterized by constriction rings, amputation of fingers or limbs and the presence of the amniotic band. However, it may also involve craniofacial disruptions, body wall defects and internal organ abnormalities. The aim of this review is to present the results found in regard to ADAM complex from its historical background, clinical manifestations, epidemiology, etc. In particular, our attention was focused on demonstrating the varying etiopathogenesis theories of ADAM complex and their contradictions. The study was conducted using the databases of PubMed, EBSCO host, Ovid, SpringerLink, Scopus, nature.com, JAMA and ScienceDirect with the following keywords for the search: "amniotic band syndrome", "amniotic band sequence", "Streeter dysplasia", "ADAM complex". In this study we used 22 full-text articles. Patients with ADAM complex require a complete pre- and postnatal evaluation to integrate the diagnosis and to decide on timely treatment. It is important for clinicians and surgeons to possess knowledge of this entity. Further research is necessary to establish a nosological basis.
Collapse
Affiliation(s)
| | - Fernando Soriano Padilla
- Cirugía Maxilofacial Pediátrica, Unidad de Medicina de Alta Especial, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México
| |
Collapse
|
31
|
Aguirre-Pascual E, Epelman M, Johnson AM, Chauvin NA, Coleman BG, Victoria T. Prenatal MRI evaluation of limb-body wall complex. Pediatr Radiol 2014; 44:1412-20. [PMID: 24928524 DOI: 10.1007/s00247-014-3026-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/01/2014] [Accepted: 05/01/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The sonographic (US) features of limb-body wall complex have been well documented; however the literature regarding the findings on MRI in limb-body wall complex is scant. OBJECTIVE To characterize the prenatal MRI features of limb-body wall complex. MATERIALS AND METHODS We performed a retrospective review of all MRI scans of fetuses diagnosed with limb-body wall complex at our institution from 2001 to 2011. Fetuses without correlating US scans or follow-up information were excluded. Three pediatric radiologists blinded to the specific US findings reviewed the prenatal MRIs. Images were evaluated for the organ location and attachment, the body part affected, characterization of the body wall defect, and spinal, limb and umbilical cord abnormalities. RESULTS Ten subjects met inclusion criteria. MRI was able to detect and characterize the body part affected and associated abnormalities. All fetuses had ventral wall defects, a small thorax and herniated liver and bowel. The kidneys were extracorporeal in three cases. The extruded organs were attached to the placenta or the uterine wall in all cases. Abnormal spinal curvatures of various degrees of severity were present in all cases. Eight cases had a short, uncoiled cord. Limb anomalies were present in 6 of the 10 cases. CONCLUSION We illustrate the common fetal MRI findings of limb-body wall complex. The prenatal diagnosis of limb-body wall complex and the differentiation of this defect from treatable abdominal wall defects are crucial to providing appropriate guidance for patient counseling and management.
Collapse
Affiliation(s)
- Elisa Aguirre-Pascual
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | |
Collapse
|
32
|
Rozendaal AM, van Essen AJ, te Meerman GJ, Bakker MK, van der Biezen JJ, Goorhuis-Brouwer SM, Vermeij-Keers C, de Walle HEK. Periconceptional folic acid associated with an increased risk of oral clefts relative to non-folate related malformations in the Northern Netherlands: a population based case-control study. Eur J Epidemiol 2013; 28:875-87. [PMID: 24092049 DOI: 10.1007/s10654-013-9849-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/02/2013] [Indexed: 11/28/2022]
Abstract
Periconceptional folic acid has been associated with a reduced risk of neural tube defects, but findings on its effect in oral clefts are largely inconclusive. This case-control study assesses the effects of periconceptional folic acid on cleft risk, using complementary data from the Dutch Oral Cleft Registry and a population-based birth defects registry (Eurocat) of children and foetuses born in the Northern Netherlands between 1997 and 2009. Cases were live-born infants with non-syndromic clefts (n = 367) and controls were infants or foetuses with chromosomal/syndromal (n = 924) or non-folate related anomalies (n = 2,021). We analyzed type/timing/duration of supplement use related to traditional cleft categories as well as to their timing (early/late embryonic periods) and underlying embryological processes (fusion/differentiation defects). Consistent supplement use during the aetiologically relevant period (weeks 0-12 postconception) was associated with an increased risk of clefts (adjusted odds ratio 1.72, 95% confidence interval 1.19-2.49), especially of cleft lip/alveolus (3.16, 1.69-5.91). Further analysis systematically showed twofold to threefold increased risks for late differentiation defects-mainly clefts of the lip/alveolus-with no significant associations for early/late fusion defects. Effects were attributable to folic acid and not to other multivitamin components, and inclusion of partial use (not covering the complete aetiologically relevant period) generally weakened associations. In conclusion, this study presents several lines of evidence indicating that periconceptional folic acid in the Northern Netherlands is associated with an increased risk of clefts, in particular of cleft lip/alveolus. This association is strengthened by the specificity, consistency, systematic pattern, and duration of exposure-response relationship of our findings, underlining the need to evaluate public health strategies regarding folic acid and to further investigate potential adverse effects.
Collapse
Affiliation(s)
- Anna M Rozendaal
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Room EE 1591, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands,
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
We present autopsy findings of a case of limb body wall complex (LBWC). The fetus had encephalocele, genitourinary agenesis, skeletal anomalies and body wall defects. The rare finding in our case is the occurrence of both cranial and urogenital anomalies. The presence of complex anomalies in this fetus, supports embryonal dysplasia theory of pathogenesis for LBWC.
Collapse
Affiliation(s)
- Panduranga Chikkannaiah
- Department of Pathology, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | | | | | | |
Collapse
|
34
|
Rittler M, Vauthay L, Mazzitelli N. Gastroschisis is a defect of the Umbilical ring: Evidence from Morphological evaluation of stillborn fetuses. ACTA ACUST UNITED AC 2013; 97:198-209. [DOI: 10.1002/bdra.23130] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 02/23/2013] [Accepted: 02/26/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Monica Rittler
- Medical Genetics Section, Department of Neonatology, Hospital Materno Infantil Ramón Sardá; University of Buenos Aires; Argentina
| | - Liliana Vauthay
- Department of Cell Biology, Histology, Embryology, and Genetics; School of Medicine; University of Buenos Aires; Argentina
| | - Nancy Mazzitelli
- Pathology Unit, Department of Diagnostics, Hospital Materno Infantil Ramón Sardá; University of Buenos Aires; Argentina
| |
Collapse
|
35
|
Bugge M. Body stalk anomaly in Denmark during 20 years (1970-1989). Am J Med Genet A 2012; 158A:1702-8. [PMID: 22653710 DOI: 10.1002/ajmg.a.35394] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 03/01/2012] [Indexed: 11/11/2022]
Abstract
Body stalk anomaly is a severe defect of the abdominal wall with uncovered thoracic and/or abdominal organs. The umbilical cord is absent or very short. Here I present epidemiological and clinical data on 16 infants with body stalk anomaly. The 16 infants represent 3.4% of the 469 infants ascertained in an almost complete nationwide data set of live- and stillborn infants born with abdominal wall defects during the two decades 1970-1989 in Denmark. The prevalence was 0.12 per 10,000 live- and stillborn. Nine of the infants were stillbirths, seven were live births, and they all died shortly after birth. The gestational age at birth varied from 33 to 40 weeks. There was an excess of males M/F ratio: 2.2 (CI: 0.85-10.71). All infants had severe associated malformations. Among the most severe were: severe limb reduction defects (56%), absence of one kidney associated with malformations of genitalia and/or urinary bladder (62%), scoliosis (82%), and anal atresia (57%). A normal karyotype was found in all eight of the infants who were tested. There were two sets of twins; one discordant and one concordant. Mean maternal and paternal ages were 28.5 and 29.5 years, respectively, not significantly different from the mean parental ages of the Danish population during the same period.
Collapse
Affiliation(s)
- Merete Bugge
- Wilhelm Johannsen Centre for Functional Genome Research, Department of Cellular and Molecular Medicine, Panum Institute, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
36
|
Karaman I, Karaman A, Erdoğan D, Cavuşoğlu YH, Ozgüner IF. The first male with thoracoschisis: case report and review of the literature. J Pediatr Surg 2011; 46:2181-3. [PMID: 22075354 DOI: 10.1016/j.jpedsurg.2011.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 08/22/2011] [Accepted: 08/22/2011] [Indexed: 10/15/2022]
Abstract
A male infant presented at birth with intestine and liver herniated through a defect 3 cm below the left nipple on the anterior thoracic wall. Riedel lobe, attached to the left liver lobe, and the transverse colon were seen protruding through the defect at the region of the left eighth intercostal space at surgery. A fibrous band extending from the lower defect border to the bladder was present. The hernia content was reduced inside the abdomen and the fibrous band, and Riedel lobe and necrotic-appearing omentum were excised. Thoracoschisis is a very rare congenital anomaly with only 4 cases reported. This is the first isolated thoracoschisis case without an accompanying diaphragmatic hernia.
Collapse
Affiliation(s)
- Ibrahim Karaman
- Department of Pediatric Surgery, Dr Sami Ulus Children's Hospital, 06080 Altındağ/Ankara/Turkey.
| | | | | | | | | |
Collapse
|
37
|
Hunter AGW, Seaver LH, Stevenson RE. Limb-body wall defect. Is there a defensible hypothesis and can it explain all the associated anomalies? Am J Med Genet A 2011; 155A:2045-59. [PMID: 21815262 DOI: 10.1002/ajmg.a.34161] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 05/21/2011] [Indexed: 11/06/2022]
Abstract
Aside from gastroschisis and omphalocele, major defects of the ventral body (thoracoabdominal) wall are relatively uncommon and almost universally lethal. They are most often associated with other anomalies including those of the limbs that may range from amelia to mild positional deformations, unusual craniofacial malformations, and a variety of visceral abnormalities that include the heart, lungs, genitourinary system, and gut. This complex of ventral wall anomalies has been discussed under a broad and changing nomenclature that has included amniotic band disruption complex, amnion rupture sequence, limb-body wall defect (or complex), and simply body wall complex. Three major theories have been suggested to explain this complex: early amnion rupture (operating through uterine pressure and/or disruption by amniotic bands), vascular compromise (primarily hypoperfusion), and an early intrinsic defect of the developing embryo. We present four patients that illustrate the spectrum of ventral body wall defects, and from there critique the current hypotheses of pathogenesis. We conclude that this association of malformations originates as early as the embryonic disc stage, and that some of the observed associated anomalies are secondary complications of the primary disturbance in embryogenesis. We propose a new explanation for the atypical facial clefts and cranial malformations that are often observed.
Collapse
Affiliation(s)
- Alasdair G W Hunter
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, South Carolina, USA.
| | | | | |
Collapse
|
38
|
Chen CP, Hsu CY, Wu PC, Tsai FJ, Wang W. Prenatal ultrasound demonstration of limb-body wall complex with megacystis. Taiwan J Obstet Gynecol 2011; 50:258-60. [PMID: 21791324 DOI: 10.1016/j.tjog.2011.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2010] [Indexed: 11/15/2022] Open
Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
| | | | | | | | | |
Collapse
|
39
|
Rao BN, Padmini MP. Limb-Body Wall Complex (LBWC)-A Rare Foetal Polymalformation. J ANAT SOC INDIA 2010. [DOI: 10.1016/s0003-2778(10)80033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Chen CP, Lee MS, Tsai FJ, Huang MC, Chern SR, Wang W. Limb-body wall complex in one fetus of a dizygotic twin pregnancy conceived by egg donation, in vitro fertilization and embryo transfer: prenatal diagnosis and literature review. Taiwan J Obstet Gynecol 2010; 48:446-50. [PMID: 20045776 DOI: 10.1016/s1028-4559(09)60344-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
41
|
Abstract
Six cases of amniotic band syndrome/limb body wall complex were studied in respect to clinicopathologic characteristics. The diagnosis was based on two out of three of the following manifestations: cranio facial clefts; limb body wall defects and amniotic band attachment. Four cases were stillborn and associated with internal defects, including central nervous system. Two cases had facial and limb defects and were live born (3-5 years old at examination). Phenotypic features of the stillborn cases were craniofacial clefting, thoracoabdominoschisis, amputation, ring constriction, amniotic band adhesion, placental adhesions, and internal malformations. Histology of bands revealed fibroconnective tissue as well as flattened epithelial cells together with neuroectodermal elements. Umbilical cord section revealed an abnormal number of vessels. When analyzing the observed data in relation to their etiology, it was found that amniotic disruption, vascular disruption or genetic disruption could explain the amniotic band syndrome/limb body wall complexes, alone or in combinations. A brief review of literature in search of pathogenesis is offered along with an etiopathogenetic model.
Collapse
Affiliation(s)
- Ashutosh Halder
- Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
42
|
Scott RJ, Fusi L. Antenatal ultrasound diagnosis in early amnion rupture. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619209025933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
43
|
Goldfarb CA, Sathienkijkanchai A, Robin NH. Amniotic constriction band: a multidisciplinary assessment of etiology and clinical presentation. J Bone Joint Surg Am 2009; 91 Suppl 4:68-75. [PMID: 19571071 DOI: 10.2106/jbjs.i.00339] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
| | | | | |
Collapse
|
44
|
Jamsheer A, Materna-Kiryluk A, Badura-Stronka M, Wiśniewska K, Wieckowska B, Mejnartowicz J, Balcar-Boroń A, Borszewska-Kornacka M, Czerwionka-Szaflarska M, Gajewska E, Godula-Stuglik U, Krawczynski M, Limon J, Rusin J, Sawulicka-Oleszczuk H, Szwałkiewicz-Warowicka E, Swietliński J, Walczak M, Latos-Bieleńska A. Comparative study of clinical characteristics of amniotic rupture sequence with and without body wall defect: further evidence for separation. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2009; 85:211-5. [PMID: 19180633 DOI: 10.1002/bdra.20555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Amniotic rupture sequence (ARS) is a disruption sequence presenting with fibrous bands, possibly emerging as a result of amniotic tear in the first trimester of gestation. Our comparative study aims to assess whether there is a difference in the clinical pattern of congenital limb and internal organ anomalies between ARS with body wall defect (ARS-BWD) and ARS without BWD (ARS-L). METHODS Among 1,706,639 births recorded between 1998 and 2006, 50 infants with a diagnosis of ARS were reported to the Polish Registry of Congenital Malformations. The information on 3 infants was incomplete, thus only 47 cases were analyzed. These infants were classified into groups of ARS-L (38 infants) and ARS-BWD (9 infants). RESULTS The ARS-BWD cases were more frequently affected by various congenital defects (overall p < 0.0001), and in particular by urogenital malformations (p = 0.003). In both groups, limb reduction defects occurred in approximately 80% of cases; however, minor and distal limb defects (phalangeal or digital amputation, pseudosyndactyly, constriction rings) predominated in the ARS-L group (p = 0.0008). The ARS-L group also had a higher frequency of hand and upper limb involvement. CONCLUSIONS This observation suggests that amniotic band adhesion in ARS-L takes place at a later development stage. Although limited by a small sample size, our study contributes to the growing evidence that both ARS entities represent two nosologically distinct conditions.
Collapse
Affiliation(s)
- Aleksander Jamsheer
- Center for Medical Genetics, Department of Medical Genetics, University of Medical Sciences in Poznań, ul. Grunwaldzka 55, Poznań, Poland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Limb-body wall complex with craniofacial defects after ovarian stimulation. Taiwan J Obstet Gynecol 2009; 47:474-5. [PMID: 19126523 DOI: 10.1016/s1028-4559(09)60024-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
46
|
Abstract
Amniotic band syndrome (ABS) has an incidence of 1/15,000. Deformities vary from rare but bizarre craniofacial defects or truncal defects to the commoner limb defects. The pathogenesis of ABS remains controversial. The following is a case of a 3-month-old infant with amniotic band syndrome with the typical limb reduction defects, a constriction band on the thigh associated with a persistent sciatic artery and bifurcation of the femur and the duplication of the knee and tibia on the contra lateral side. The anatomy of the persistent sciatic artery is demonstrated in magnetic resonance angiography and digital subtraction angiography. The vascular anomaly was unilateral. The patient underwent surgical correction of the constriction band by excision and multiple Z plasty. This case is the first description of the coexistence of ABS and persistent sciatic artery. Persistent sciatic artery has angiographic incidence of 0.05%. Is this purely a coincidence? Or perhaps their coexistence may serve to further the understanding of the mechanism of ABS.
Collapse
|
47
|
Chen CP. Syndromes, Disorders and Maternal Risk Factors Associated with Neural Tube Defects (III). Taiwan J Obstet Gynecol 2008; 47:131-40. [DOI: 10.1016/s1028-4559(08)60070-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
48
|
Ross MG. Pathogenesis of amniotic band syndrome. Am J Obstet Gynecol 2007; 197:219-20; author reply 220. [PMID: 17689662 DOI: 10.1016/j.ajog.2007.03.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 03/26/2007] [Indexed: 10/23/2022]
|
49
|
Chen CP. Syndromes and Disorders Associated with Omphalocele (II): OEIS Complex and Pentalogy Of Cantrell. Taiwan J Obstet Gynecol 2007; 46:103-10. [PMID: 17638617 DOI: 10.1016/s1028-4559(07)60003-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex is characterized by a combination of omphalocele, exstrophy of the bladder, an imperforate anus, and spinal defects. Pentalogy of Cantrell is characterized by a combination of a midline supraumbilical abdominal wall defect, a defect of the lower sternum, a defect of the diaphragmatic pericardium, a deficiency of the anterior diaphragm, and congenital cardiac anomalies. This article provides a comprehensive review of OEIS complex and pentalogy of Cantrell, including the pathogenesis, prenatal diagnosis, differential diagnosis, and associated malformations. Omphalocele is an important sonographic marker for OEIS complex and pentalogy of Cantrell. Prenatal detection of an abdominal wall defect associated with multiple midline defects should alert one to the possibility of OEIS complex and pentalogy of Cantrell and prompt the genetic investigation and counseling of the disorders.
Collapse
MESH Headings
- Abdominal Wall/abnormalities
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/genetics
- Anus, Imperforate/diagnosis
- Anus, Imperforate/genetics
- Bladder Exstrophy/diagnosis
- Bladder Exstrophy/genetics
- Diagnosis, Differential
- Female
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/genetics
- Hernia, Diaphragmatic/diagnosis
- Hernia, Diaphragmatic/genetics
- Hernia, Umbilical/etiology
- Hernias, Diaphragmatic, Congenital
- Humans
- Pregnancy
- Prenatal Diagnosis
- Spinal Dysraphism/diagnosis
- Spinal Dysraphism/genetics
- Sternum/abnormalities
Collapse
Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
| |
Collapse
|
50
|
Davies BR, Giménez-Scherer JA. Comparison of the amniotic band disruption complex with acardiac twins does not support its vascular origin. Fetal Pediatr Pathol 2007; 26:87-99. [PMID: 17701691 DOI: 10.1080/15513810701448466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The amniotic band disruption complex (ABDC) has been attributed to vascular disruption by some authors, not by others. Acardiac twins (ATs), however, have been generally accepted as a prime example of vascular disruption. In this study a comparison was made of these two entities to determine if they were similar or not, and thus we attempted to resolve the controversy of the mechanisms in the ABDC. A female tendency (2:1) was found in the ABDC in contrast to the "normal" sex distribution (0.88:1) in the ATs (p < 0.001). Most types of malformations (66%) were mutually exclusive, notably those of the cranium/brain, abdominal wall, and most internal organs; 83% were more significantly related to one or other of the entities. The ABDC malformations tended to occur unilaterally, but in the ATs they occurred bilaterally (p < 0.0001); the former tended to involve external organs and the latter internal organs (p < 0.0001). With so many differences, the two entities are unlikely due to the same mechanism: the ABDC is more likely to be due to external disruption.
Collapse
Affiliation(s)
- Belinda R Davies
- Department of Anatomic Pathology, General Hospital of Mexico, Mexico City, 06726 Mexico.
| | | |
Collapse
|