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Devavarapu PKV, Uppaluri KR, Nikhade VA, Palasamudram K, Sri Manjari K. Exploring the complexities of megacystis-microcolon-intestinal hypoperistalsis syndrome: insights from genetic studies. Clin J Gastroenterol 2024; 17:383-395. [PMID: 38461165 DOI: 10.1007/s12328-024-01934-x] [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] [Received: 08/03/2023] [Accepted: 01/30/2024] [Indexed: 03/11/2024]
Abstract
Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is an uncommon genetic disorder inherited in an autosomal recessive pattern that affects the muscles that line the bladder and intestines. The most common genes associated with MMIHS mutations are ACTG2, LMOD1, MYH11, MYL9, MYLK, and PDCL3. However, the complete genetic landscape of MMIHS still needs to be fully understood. The diagnosis of MMIHS can be challenging. However, advances in prenatal and diagnostic techniques, such as ultrasound and fetal urine analysis, have improved the ability to detect the syndrome early. Targeted next-generation sequencing (NGS) and other diagnostic tests can also diagnose MMIHS. The management of MMIHS involves addressing severe intestinal dysmotility, which often necessitates total parenteral nutrition (TPN), which can lead to complications such as hepatotoxicity and nutritional deficiencies. Multivisceral and intestinal transplantation has emerged as therapeutic options, offering the potential for improved outcomes and enteral autonomy. Understanding the genetic underpinnings of MMIHS is crucial for personalized care. While the prognosis varies, timely interventions and careful monitoring enhance patient outcomes. Genetic studies have given us valuable insights into the molecular mechanisms of MMIHS. These studies have identified mutations in genes involved in the development and function of smooth muscle cells. They have also shown that MMIHS is associated with defects in the signaling pathways that control muscle contraction. Continued research in the genetics of MMIHS holds promise for unraveling the complexities of MMIHS and improving the lives of affected individuals.
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Affiliation(s)
- Prasad K V Devavarapu
- Department of Biochemistry, GITAM Institute of Medical Sciences & Research, Rushikonda, Visakhapatnam, Andhra Pradesh, 530045, India
| | - Kalyan Ram Uppaluri
- GenepoweRx, Suit #2B, Plot No. 240, Nirvana, Road No. 36, Jawahar Colony, Jubilee Hills, Hyderabad, Telangana, 500033, India
| | - Vrushabh Anil Nikhade
- KIT's College of Engineering (Autonomous), Kolhapur, Maharashtra, 416234, India
- GenepoweRx, Suit #2B, Plot No. 240, Nirvana, Road No. 36, Jawahar Colony, Jubilee Hills, Hyderabad, Telangana, 500033, India
| | - Kalyani Palasamudram
- GenepoweRx, Suit #2B, Plot No. 240, Nirvana, Road No. 36, Jawahar Colony, Jubilee Hills, Hyderabad, Telangana, 500033, India
| | - Kavutharapu Sri Manjari
- GenepoweRx, Suit #2B, Plot No. 240, Nirvana, Road No. 36, Jawahar Colony, Jubilee Hills, Hyderabad, Telangana, 500033, India.
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Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome (MMIHS): Series of 4 Cases Caused by Mutation of ACTG2 (Actin Gamma 2, Smooth Muscle) Gene. Case Rep Gastrointest Med 2021; 2021:6612983. [PMID: 33859849 PMCID: PMC8026316 DOI: 10.1155/2021/6612983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
MMIHS, also known as Berdon's syndrome, is a rare disease that belongs to primary causes of CIPOS (chronic intestinal pseudoobstruction syndrome). Clinical characteristics of MMIHS are differential, but we come across the following classic symptoms: disorders of intestinal peristalsis, microcolon, and megacystis. In this article, we present a series of 4 patients with Berdon's syndrome, in whom we managed to identify the genetic causes of MMIHS. All infants showed clinical features of bowel obstruction and dysfunction of the urinary system after birth. Two of them also manifested disorders from other systems. The prognosis for these patients is poor, but a constant betterment of management in MMIHS, in which the leading role plays TPN (total parental nutrition), causes improvement of patients' survival.
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Lim J, Hua J, Arcement C. Imaging findings of a twin male neonate with megacystis microcolon intestinal hypoperistalsis syndrome. Radiol Case Rep 2021; 16:628-630. [PMID: 33437344 PMCID: PMC7788490 DOI: 10.1016/j.radcr.2020.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/17/2022] Open
Abstract
Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a rare congenital defect of the bowel and bladder that is especially rare in males. We present a case of MMIHS in a male nonidentical twin neonate who presented with abdominal distention, urinary retention, and hypoplastic bowel. The voiding cystourethrogram included in this report displays rare image of MMIHS in a male urogenital system. The constellation of clinical and imaging findings presented in this case are characteristic of MMIHS and may aid the early diagnosis of male neonates affected by this disease.
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Affiliation(s)
- Jennifer Lim
- Tulane University Medical Center, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Jack Hua
- Children's Hospital New Orleans, 200 Henry Clay Avenue, New Orleans, LA 70118, USA.,Tulane University Medical Center, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Christopher Arcement
- Children's Hospital New Orleans, 200 Henry Clay Avenue, New Orleans, LA 70118, USA.,Tulane University Medical Center, 1430 Tulane Avenue, New Orleans, LA 70112, USA
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Surd A, Gheban D, Mironescu A, Aldea C, Gocan H. Megacystis-microcolon-intestinal hypoperistalsis syndrome associated with cystic fibrosis and meconium peritonitis in a female neonate 4 days of age - case report and review of the literature. Med Pharm Rep 2020; 93:422-427. [PMID: 33225270 PMCID: PMC7664722 DOI: 10.15386/mpr-1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/07/2020] [Accepted: 05/21/2020] [Indexed: 11/23/2022] Open
Abstract
We present a case of megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) in a four days old female infant who presented with abdominal distension, bilious vomiting, massive hematuria and feeding intolerance which was first interpreted as Prune Belly Syndrome (PBS), referred to our department after iatrogenic gastric and colonic perforation. Berdon syndrome or MMIHS is a rare congenital anomaly characterized by a massive enlarged bladder, distended abdomen, microcolon, functional obstruction of the gastrointestinal tract, and malrotation.
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Affiliation(s)
- Adrian Surd
- Pediatric Surgery Department, Emergency Children's Hospital, Cluj-Napoca, Romania
| | - Dan Gheban
- Pathology Department, Emergency Children's Hospital, Cluj-Napoca, Romania
| | - Aurel Mironescu
- Pediatric Surgery Department, Children's Hospital, Brasov, Romania
| | - Cornel Aldea
- Pediatric Nephrology Department, Emergency Children's Hospital, Cluj-Napoca, Romania
| | - Horaţiu Gocan
- Pediatric Surgery Department, Emergency Children's Hospital, Cluj-Napoca, Romania
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Kocoshis SA, Goldschmidt ML, Nathan JD, El-Chammas KI, Bondoc AJ, Tiao GM, Alonso MH, Ubesie AC, Cole CR, Kaul A. Esophageal dysmotility: An intrinsic feature of megacystis, microcolon, hypoperistalsis syndrome (MMIHS). J Pediatr Surg 2019; 54:1303-1307. [PMID: 30257810 DOI: 10.1016/j.jpedsurg.2018.08.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/02/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Megacystis-microcolon-hypoperistalsis syndrome (MMIHS) also called Berdon's Syndrome, is a smooth muscle myopathy that results in an enlarged bladder, microcolon, and small bowel hypoperistalsis. In our series of six patients with this disorder, all had disordered swallowing. Therefore, we prospectively characterized esophageal structure and function in all. METHODS Diagnoses had been established by contrast radiography, small bowel manometry, and urodynamic studies. To investigate the esophagus, we endoscoped and biopsied the esophagus of each patient on multiple occasions. All patients also underwent water soluble contrast esophagography and esophageal manometry. RESULTS Upon careful questioning, all patients had swallowing dysfunction, and the majority of their enteral intake was via gastrostomy or gastrojejunostomy. All took some oral alimentation, but eating was slow and none could aliment themselves completely by the oral route, receiving 50% or less of their calories by mouth. Four had megaesophagus whereas the esophagus of the two youngest was of normal caliber. All had eosinophilic esophagitis and/or esophageal Candidiasis from time to time, but successful treatment of these findings failed to improve their symptoms. Manometry revealed normal lower esophageal sphincter (LES) resting tone and normal LES relaxation, but for all, peristalsis was absent in the esophageal body. CONCLUSIONS This series expands the spectrum of findings in MMIHS, to include a primary motility disorder of the esophageal body. As patients age, the esophageal caliber appears to increase. Successful treatment of neither esophageal eosinophilia nor Candidiasis is effective in ameliorating the motility disorder. If our findings are confirmed in more patients with MMIHS, this disorder should be renamed, megacystis-microcolon-intestinal-and esophageal hypoperistalsis syndrome. TYPE OF STUDY Prognosis study, Level IV (case series).
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Affiliation(s)
- Samuel A Kocoshis
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, The Ohio State University College of Medicine and Nationwide Children's Hospital.
| | | | - Jaimie D Nathan
- Department Surgery, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, The Ohio State University College of Medicine and Nationwide Children's Hospital
| | - Khalil I El-Chammas
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, The Ohio State University College of Medicine and Nationwide Children's Hospital
| | - Alexander J Bondoc
- Department Surgery, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, The Ohio State University College of Medicine and Nationwide Children's Hospital
| | - Gregory M Tiao
- Department Surgery, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, The Ohio State University College of Medicine and Nationwide Children's Hospital
| | - Maria H Alonso
- Department Surgery, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, The Ohio State University College of Medicine and Nationwide Children's Hospital
| | | | - Conrad R Cole
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, The Ohio State University College of Medicine and Nationwide Children's Hospital
| | - Ajay Kaul
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, The Ohio State University College of Medicine and Nationwide Children's Hospital
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Nakamura H, O'Donnell AM, Puri P. Consanguinity and its relevance for the incidence of megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS): systematic review. Pediatr Surg Int 2019; 35:175-180. [PMID: 30386895 DOI: 10.1007/s00383-018-4390-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a rare congenital and generally fatal cause of functional intestinal obstruction in the newborn. The cause of this syndrome is unknown. Familial occurrence and reports of consanguinity in MMIHS implies that genetic factors may have an important role in the pathogenesis of this syndrome. The aim of the study was to determine the consequence of consanguinity for the incidence of MMIHS. METHODS A literature search was performed using the keywords "megacystis microcolon intestinal hypoperistalsis" for studies published between 1976 and 2018. Retrieved articles, including additional studies from reference lists, were reviewed for consanguinity between parents and recurrence of MMIHS between siblings. Data were extracted for cases where familial MMIHS was present. RESULTS A total of 450 patients with the diagnosis of MMIHS have been reported in the literature. There were 56 (12%) cases in which familial MMIHS was confirmed, 25 families with multiple siblings and 3 families with single affected infant. Of the 25 families with multiple siblings, 22 families had 2 siblings with confirmed MMIHS and 3 families had 3 children each with MMIHS. Consanguinity between parents was confirmed in 30 cases (18 siblings and 12 individual cases). Female-to-male ratio in the 30 patients was 4.4:1. CONCLUSION The occurrence of MMIHS in the offspring of consanguineous parents and recurrence in siblings of healthy parents suggest that MMIHS is an autosomal recessive disorder. Pre-marital and pre-conception counselling of consanguineous populations is recommended to prevent harmful consequences.
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Affiliation(s)
- Hiroki Nakamura
- National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Anne Marie O'Donnell
- National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Prem Puri
- National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland. .,School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical, Research University College Dublin, Dublin, Ireland.
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Takasaki C, Yoshihara T, Yawaka Y. Oral findings in a patient with megacystis microcolon intestinal hypoperistalsis syndrome: A case report. PEDIATRIC DENTAL JOURNAL 2018. [DOI: 10.1016/j.pdj.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Pena J, Quinn KH, Jorizzo JR, Nitsche JF, Denney JM. Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome: An Unusual In Utero Presentation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1283-1286. [PMID: 29027710 DOI: 10.1002/jum.14450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Juan Pena
- Section for Maternal-Fetal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristen H Quinn
- Section for Maternal-Fetal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Johanna R Jorizzo
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Joshua F Nitsche
- Section for Maternal-Fetal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jeffrey M Denney
- Section for Maternal-Fetal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Korğalı EÜ, Yavuz A, Şimşek CEÇ, Güney C, Kurtulgan HK, Başer B, Atalar MH, Özer H, Eğilmez HR. Megacystis Microcolon Intestinal Hypoperistalsis Syndrome in Which a Different De Novo Actg2 Gene Mutation was Detected: A Case Report. Fetal Pediatr Pathol 2018; 37:109-116. [PMID: 29608093 DOI: 10.1080/15513815.2018.1445149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is characterized by bladder distension without urinary tract obstruction, decreased or absent intestinal peristalsis and microcolon. Although the definitive cause remains unknown, changes in the ACTG2 gene are thought to be responsible for the intestinal and bladder hypoperistalsis. CASE REPORT This female newborn with MMIHS had a c.532C>A /p.Arg178Ser heterozygous de novo mutation detected in the ACTG2 gene. Normal immature ganglion cells, normal calretinin punctate positivity, maintence of smooth muscle actin immunoreactivity, and decreased numbers of interstitial cells of Cajal(ICCs) were detected. CONCLUSION This previously unreported c.532C>A /p.Arg178Ser heterozygous de novo mutation in the ACTG2 gene may lead to a severe form of MMIHS.
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Affiliation(s)
- Elif Ünver Korğalı
- a Cumhuriyet University , Faculty of Medicine, Department of Pediatrics , Sivas , Turkey
| | - Amine Yavuz
- a Cumhuriyet University , Faculty of Medicine, Department of Pediatrics , Sivas , Turkey
| | | | - Cengiz Güney
- b Cumhuriyet Universitesi , Department of Pediatric Surgery , Sivas , Turkey
| | - Hande Küçük Kurtulgan
- c Cumhuriyet University Faculty of Medicine, Department of Medical Genetics , Sivas , Turkey
| | - Burak Başer
- c Cumhuriyet University Faculty of Medicine, Department of Medical Genetics , Sivas , Turkey
| | - Mehmet Haydar Atalar
- d Cumhuriyet University Faculty of Medicine, Department of Radiology , Sivas , Turkey
| | - Hatice Özer
- e Cumhuriyet University Faculty of Medicine, Department of Pathology , Sivas , Turkey
| | - Hatice Reyhan Eğilmez
- e Cumhuriyet University Faculty of Medicine, Department of Pathology , Sivas , Turkey
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Zespół Berdona oraz zespół suszonej śliwki i ich współistnienie − analiza przypadków. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.pepo.2017.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wymer KM, Anderson BB, Wilkens AA, Gundeti MS. Megacystis microcolon intestinal hypoperistalsis syndrome: Case series and updated review of the literature with an emphasis on urologic management. J Pediatr Surg 2016; 51:1565-73. [PMID: 27421821 DOI: 10.1016/j.jpedsurg.2016.06.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/14/2016] [Accepted: 06/19/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Megacystis microcolon intestinal hypoperistalsis (MMIHS) is a rare disorder characterized by distended nonobstructed bladder, microcolon, and decreased intestinal peristalsis. MMIHS has a particularly poor prognosis; however, when appropriately managed, survival can be prolonged. STUDY DESIGN A systematic review (1996-2016) was performed with the key words "megacystis microcolon intestinal hypoperistalsis syndrome." In addition, a case series of four patients is presented as well as algorithms for the diagnosis and treatment of MMIHS. RESULTS 135 patients with MMIHS were identified in the literature. 73% (88/121) of the patients were female, 65% underwent diagnostic biopsy (64/99), and 63% (66/106) were identified with prenatal imaging. The majority of patients were treated with TPN as well as gastrostomy or ileostomy and CIC, however 15% (18/116) received multivisceral or intestinal transplant, and 30% (22/73) had a vesicostomy. The survival rate was 57% (68/121). CONCLUSION Appropriate management of MMIHS patients is crucial. An enlarged, acontractile bladder in a child with bowel motility problems should be considered diagnostic. Bladder distension can be managed with CIC or vesicostomy in addition to prophylactic antibiotics if frequent urinary tract infections are present. These patients often require gastrostomy or ileostomy as well as total parenteral nutrition. This management has led to significant improvement in survival rates.
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De Sousa J, Upadhyay V, Stone P. Megacystis Microcolon Intestinal Hypoperistalsis Syndrome: Case Reports and Discussion of the Literature. Fetal Diagn Ther 2015; 39:152-7. [DOI: 10.1159/000442050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022]
Abstract
Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a rare intestinal dysmotility condition that also involves a dilated urinary bladder. It was believed to be an autosomal recessive condition, but genetic studies have suggested possibly an autosomal dominant inheritance pattern. Prenatal diagnosis can be challenging, but MRI and amniotic fluid/digestive fluid studies may be complementary investigations to improve diagnostic accuracy. Prognosis of MMIHS is generally poor and treatment is mostly supportive. To date, bowel transplantation remains the only viable treatment to restore bowel motility. Here we present two additional cases to contribute towards the scant literature on this condition.
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Stewart MS, Dietz RM, Landman MP, Moulton SL, Wright CJ. Abdominal radiograph with intravesical air and possible small bowel atresia. J Pediatr 2014; 164:1238-1238.e1. [PMID: 24472230 PMCID: PMC5497830 DOI: 10.1016/j.jpeds.2013.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 12/11/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Michael S. Stewart
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert M. Dietz
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew P. Landman
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Steven L. Moulton
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Clyde J. Wright
- Section of Neonatology, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Mc Laughlin D, Puri P. Familial megacystis microcolon intestinal hypoperistalsis syndrome: a systematic review. Pediatr Surg Int 2013; 29:947-51. [PMID: 23955298 DOI: 10.1007/s00383-013-3357-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a rare and severe disorder of functional obstruction affecting bladder and bowel, usually diagnosed in the neonatal period. Over 230 cases have been reported since Berdon and colleagues first described this clinical entity in 1976. The exact pathogenesis of MMIHS is unknown. Familial occurrence of MMIHS has been reported and could offer insight into the aetiology of this disease. The purpose of this study was to systematically review the published literature for the evidence of familial MMIHS and to characterise these presentations. METHODS A literature search was performed using the keywords "megacystis microcolon intestinal hypoperistalsis" (1976-2013). Retrieved articles, including additional studies from reference lists, were reviewed for consanguinity between parents and recurrence of MMIHS between siblings. Data were extracted for cases where familial MMIHS was present. RESULTS A total of 47 patients were reported in which familial MMIHS was likely or confirmed. 15 sibling sets were definitively diagnosed with MMIHS (14 pairs and one set of three siblings). Four further index patients with a confirmed diagnosis and also one of the sibling pairs were reported to have a sibling in which MMIHS was probable. Consanguinity between parents was present in four of the confirmed sibling sets and in an additional seven individual cases. The outcome for familial MMIHS is generally poor. Multiple sibling fatalities were frequent and in only one family were both siblings' survivors at the time of reporting. CONCLUSION Consanguinity between parents and recurrence in siblings indicate that MMIHS is inherited in an autosomal recessive manner. With the advent of next generation sequencing, these familial clusters may be key to determining the genetic basis for MMIHS.
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Affiliation(s)
- Danielle Mc Laughlin
- National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
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