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Thapa J, Pandey A, Pandey A, Keshari S, Bista K, Chaudhary A. Sacral agenesis without maternal diabetes: a case report. Ann Med Surg (Lond) 2023; 85:5670-5674. [PMID: 37915662 PMCID: PMC10617844 DOI: 10.1097/ms9.0000000000001277] [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] [Received: 07/18/2023] [Accepted: 08/26/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Sacral agenesis is a rare congenital condition that is characterized by sacrococcygeal bone agenesis. It is associated with spinal cord anomalies as well as problems with the genitourinary system, large bowel, and lower extremities. Fetal ultrasound allows for diagnosis even before birth. Case presentation The authors present the case of a 1-year-old girl with sacral agenesis type III and bilateral congenital talipes equinovarus with spina bifida who was born to a nondiabetic mother and had a normal anomaly scan. Clinical discussion People with less severe forms of sacral agenesis can live a normal life, and it is not connected with cognitive impairment; however, concomitant bladder, colon, and lower limb disorders cause considerable morbidity. The majority of treatment is supportive, frequently requiring orthopedic, urological, gastroenterological, pediatric, and physiotherapy support. Conclusion Genetic and prepregnancy counseling, as well as early screening of high-risk mothers, remain the only options for prevention of the disease since treatment is mostly supportive.
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Affiliation(s)
- Jagadish Thapa
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel
| | - Abhishek Pandey
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel
| | - Archana Pandey
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel
| | - Suraj Keshari
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel
| | - Karuna Bista
- Nepal Medical College, Attarkhel, Gokarneshwor, Nepal
| | - Aashutosh Chaudhary
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel
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Bhutani J, Rengan V, Pansari V, Kannan D. Sacral Agenesis: Late Presentation and the Psychological Impact of Delayed Diagnosis. Cureus 2023; 15:e47456. [PMID: 38021544 PMCID: PMC10660888 DOI: 10.7759/cureus.47456] [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: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Sacral agenesis (SA) is a rare condition characterized by the absence of one or more lower sacral vertebral bodies. In India, children with this condition often present late with symptoms primarily related to urinary and bowel dysfunction. Maternal diabetes is the only confirmed risk factor, significantly elevating the incidence rate. We discuss a case of a nine-year-old female who presented to the pediatric outpatient department (OPD) with chronic constipation and urinary retention, having experienced symptoms since infancy. Initial investigations at peripheral hospitals had yielded no clear diagnosis, leading to undue psychological distress to the child and family. The child had been born to a mother with diabetes mellitus during pregnancy. Physical examination revealed mild dehydration, anemia, and sacral dimpling. Further evaluation showed renal injury and SA confirmed by MRI, along with other associated findings. This case report highlights the importance of early diagnosis and intervention in pediatric SA, especially given the risk of renal disease progression. The treatment in this case included clean intermittent self-catheterization (CIC), dietary management, and counseling on renal health. Crucially, uncovering the root cause provided immense psychological relief to the child and her family. Pediatric SA remains a diagnostic challenge, often leading to psychological distress in affected individuals who present late. Early recognition and comprehensive management are crucial, especially in cases associated with maternal diabetes, to mitigate the risk of renal complications and improve the overall quality of life for affected children.
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Qudsieh H, Aborajooh E, Daradkeh A. Caudal regression syndrome: Postnatal radiological diagnosis with literature review of 83 cases. Radiol Case Rep 2022; 17:4636-4641. [PMID: 36204402 PMCID: PMC9530488 DOI: 10.1016/j.radcr.2022.09.037] [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: 08/11/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 11/18/2022] Open
Abstract
Caudal regression syndrome (CRS) is a rare congenital disorder characterized by arrest of caudal spinal growth and associated with wide spectrum multisystemic anomalies. Herein, we presented a case of a newborn baby who did not pass meconium due to imperforated anus and was referred to the pediatric surgeon for urgent diverting loop colostomy. The conventional X-ray, abdominal ultrasound and abdominal pelvic magnetic resonance imaging (1.5 T) at 2-month-old age revealed right kidney agenesis, sacrococcygeal agenesis, vertebral bodies dysraphism and the spinal cord ends at D12-L1 with anterior and posterior bands of the terminating filaments. The diagnosis of CRS was confirmed. Through this case report, we hope to draw attention to this rare syndrome and the wide range of associated anomalies, also to consider this syndrome on the top of differential diagnosis list once the newborn has anorectal malformation mainly imperforated anus.
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Affiliation(s)
- Hana’ Qudsieh
- Department of Medicine and Radiology, Faculty of Medicine, Mutah University, Karak, 61710, Jordan
- Corresponding author.
| | - Emad Aborajooh
- General Surgery and Anesthesia Department, Faculty of Medicine, Mutah University, Karak, 61710, Jordan
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Pitsava G, Feldkamp ML, Pankratz N, Lane J, Kay DM, Conway KM, Hobbs C, Shaw GM, Reefhuis J, Jenkins MM, Almli LM, Moore C, Werler M, Browne ML, Cunniff C, Olshan AF, Pangilinan F, Brody LC, Sicko RJ, Finnell RH, Bamshad MJ, McGoldrick D, Nickerson DA, Mullikin JC, Romitti PA, Mills JL. Exome sequencing identifies variants in infants with sacral agenesis. Birth Defects Res 2022; 114:215-227. [PMID: 35274497 PMCID: PMC9338687 DOI: 10.1002/bdr2.1987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/22/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sacral agenesis (SA) consists of partial or complete absence of the caudal end of the spine and often presents with additional birth defects. Several studies have examined gene variants for syndromic forms of SA, but only one has examined exomes of children with non-syndromic SA. METHODS Using buccal cell specimens from families of children with non-syndromic SA, exomes of 28 child-parent trios (eight with and 20 without a maternal diagnosis of pregestational diabetes) and two child-father duos (neither with diagnosis of maternal pregestational diabetes) were exome sequenced. RESULTS Three children had heterozygous missense variants in ID1 (Inhibitor of DNA Binding 1), with CADD scores >20 (top 1% of deleterious variants in the genome); two children inherited the variant from their fathers and one from the child's mother. Rare missense variants were also detected in PDZD2 (PDZ Domain Containing 2; N = 1) and SPTBN5 (Spectrin Beta, Non-erythrocytic 5; N = 2), two genes previously suggested to be associated with SA etiology. Examination of variants with autosomal recessive and X-linked recessive inheritance identified five and two missense variants, respectively. Compound heterozygous variants were identified in several genes. In addition, 12 de novo variants were identified, all in different genes in different children. CONCLUSIONS To our knowledge, this is the first study reporting a possible association between ID1 and non-syndromic SA. Although maternal pregestational diabetes has been strongly associated with SA, the missense variants in ID1 identified in two of three children were paternally inherited. These findings add to the knowledge of gene variants associated with non-syndromic SA and provide data for future studies.
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Affiliation(s)
- Georgia Pitsava
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcia L. Feldkamp
- Division of Medical Genetics, Department of Pediatrics, 295 Chipeta Way, Suite 2S010, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nathan Pankratz
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - John Lane
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Denise M. Kay
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Kristin M. Conway
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - Charlotte Hobbs
- Rady Children’s Institute for Genomic Medicine, San Diego, California, USA
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary M. Jenkins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lynn M. Almli
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Martha Werler
- Slone Epidemiology Center at Boston University, Boston, MA
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA
| | - Marilyn L. Browne
- New York State Department of Health, Birth Defects Registry, Albany, New York, USA
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York, USA
| | - Chris Cunniff
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Faith Pangilinan
- Gene and Environment Interaction Section, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Lawrence C. Brody
- Gene and Environment Interaction Section, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Robert J. Sicko
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Richard H. Finnell
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, Texas, USA
| | - Michael J. Bamshad
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Daniel McGoldrick
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Deborah A. Nickerson
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - James C. Mullikin
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - James L. Mills
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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Kang S, Park H, Hong J. Clinical and Radiologic Characteristics of Caudal Regression Syndrome in a 3-Year-Old Boy: Lessons from Overlooked Plain Radiographs. Pediatr Gastroenterol Hepatol Nutr 2021; 24:238-243. [PMID: 33833979 PMCID: PMC8007840 DOI: 10.5223/pghn.2021.24.2.238] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 12/04/2022] Open
Abstract
Caudal regression syndrome (CRS) is a rare neural tube defect that affects the terminal spinal segment, manifesting as neurological deficits and structural anomalies in the lower body. We report a case of a 31-month-old boy presenting with constipation who had long been considered to have functional constipation but was finally confirmed to have CRS. Small, flat buttocks with bilateral buttock dimples and a short intergluteal cleft were identified on close examination. Plain radiographs of the abdomen, retrospectively reviewed, revealed the absence of the distal sacrum and the coccyx. During the 5-year follow-up period, we could find his long-term clinical course showing bowel and bladder dysfunction without progressive neurologic deficits. We present this case to highlight the fact that a precise physical examination, along with a close evaluation of plain radiographs encompassing the sacrum, is necessary with a strong suspicion of spinal dysraphism when confronting a child with chronic constipation despite the absence of neurologic deficits or gross structural anomalies.
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Affiliation(s)
- Seongyeon Kang
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea
| | - Heewon Park
- Department of Rehabilitation, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jeana Hong
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea.,Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
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Freixo M, Soares E, Coelho M, Marinho C, Rocha J, Rodrigues G. Skeletal Defect at First-trimester Ultrasound Scan. J Med Ultrasound 2020; 29:226-228. [PMID: 34729338 PMCID: PMC8515628 DOI: 10.4103/jmu.jmu_62_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/19/2020] [Accepted: 06/02/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Marília Freixo
- Department of Obstetrics and Gynaecology, Centro Hospitalar Tâmega E Sousa, Porto, Portugal
| | - Elisa Soares
- Department of Obstetrics and Gynaecology, Centro Hospitalar Tâmega E Sousa, Porto, Portugal
| | - Maria Coelho
- Department of Obstetrics and Gynaecology, Centro Hospitalar Tâmega E Sousa, Porto, Portugal
| | - Carla Marinho
- Department of Obstetrics and Gynaecology, Centro Hospitalar Tâmega E Sousa, Porto, Portugal
| | - Juliana Rocha
- Department of Obstetrics and Gynaecology, Centro Hospitalar Tâmega E Sousa, Porto, Portugal
| | - Graça Rodrigues
- Department of Obstetrics and Gynaecology, Centro Hospitalar Tâmega E Sousa, Porto, Portugal
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Warner T, Scullen TA, Iwanaga J, Loukas M, Bui CJ, Dumont AS, Tubbs RS. Caudal Regression Syndrome-A Review Focusing on Genetic Associations. World Neurosurg 2020; 138:461-467. [PMID: 32200015 DOI: 10.1016/j.wneu.2020.03.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/31/2022]
Abstract
Caudal regression syndrome (CRS) represents a spectrum of clinical phenotypes with varying degrees of malformation of the lower body with involvement of structures deriving from all 3 layers of the trilaminar embryo. We review areas of active investigation in the diagnosis, etiology, epidemiology, and treatment of the disease with a focus on underlying genetics. CRS pathobiology is complex and multifactorial with a significant contribution from environmental factors as evidenced in twin studies. Contemporary genomic and genetic investigations in both human primary tissue and murine in vitro and in vivo models implicate various genes associated with caudal differentiation and neural cell migration in embryogenesis. A large number of identified targets center around the metabolic regulation of retinoic acid and its derivatives. Dysregulation of retinoic acid homeostasis has been associated with abnormal embryonic cell migration, differentiation, and organogenesis with resulting malformations and agenesis in both a laboratory and a clinical setting. There appears to be a significant overlap in potential genetic targets with CRS and other developmental syndromes with similar presentations, such as VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) association. CRS represents a spectrum of caudal developmental abnormalities with treatment options limited to mild and moderate expressions of disease. Continued research is necessary to further clarify mechanisms of disease pathobiology and complex polygenetic and environmental interaction. Despite this, progress has been made in identifying genetic targets and downstream effectors contributing to preclinical and clinical progression.
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Affiliation(s)
- Tyler Warner
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Tyler A Scullen
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - C J Bui
- Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
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9
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Chawla GS, Agrawal PM, Bajwa KS. A Rare Case of Caudal Regression Syndrome in a Foetus of Non-Diabetic Mother: A Case Report. Pol J Radiol 2017; 82:621-624. [PMID: 29657626 PMCID: PMC5894013 DOI: 10.12659/pjr.903275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/10/2017] [Indexed: 11/21/2022] Open
Abstract
Backgound Caudal regression syndrome (CRS) is an uncommon disorder in which there is abnormal development of the caudal end of the foetal spine along with many associated anomalies. Manifestations of this syndrome can vary from the absence of a few terminal coccygeal segments to complete lumbosacral agenesis. Its overall incidence is 1 in 60000 live births. It is more commonly seen in infants of diabetic mothers, with a 200-fold increased risk as compared to the general population. Case Report We present a case of CRS in a foetus of a non-diabetic mother and discuss the role of radiology in early diagnosis and timely management. We also correlate initial abnormalities of the nervous system found on imaging with postnatal clinical deficits. Conclusions This case highlights the rarity caudal regression syndrome in a foetus of a non-diabetic mother. Early diagnosis of CRS is important for appropriate management.
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Affiliation(s)
- Gurnihal Singh Chawla
- Department of Radiology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - Purva Mahesh Agrawal
- Department of Radiology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - Karanbir Singh Bajwa
- Department of Radiology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
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Bouchahda H, El Mhabrech H, Hamouda HB, Ghanmi S, Bouchahda R, Soua H. Prenatal diagnosis of caudal regression syndrome and omphalocele in a fetus of a diabetic mother. Pan Afr Med J 2017; 27:128. [PMID: 28904658 PMCID: PMC5568004 DOI: 10.11604/pamj.2017.27.128.12041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 06/03/2017] [Indexed: 11/18/2022] Open
Abstract
The caudal regression syndrome is defined as total or partial agenesis of the sacrum and lumbar spine, frequently associated with other developmental malformations (orthopedic, neurological, genito-urinary, gastrointestinal…). Prenatal diagnosis is possible through fetal ultrasound (US) and magnetic resonance imaging (MRI). A case of fetal caudal regression syndrome with omphalocele from a diabetic mother is presented, demonstrating the sonographic, MRI, CT and X-Ray features diagnostic. We will also discuss neonatal findings, risk factors and prognosis of this condition.
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Affiliation(s)
- Haifa Bouchahda
- Department of Gynecology Obstetric, University of Monastir, Tahar Sfar University Hospital, 5111 Mahdia, Tunisia
| | - Houda El Mhabrech
- Department of Radiology, University of Monastir, Maternal and Fetal Unit, Fattouma Bourguiba University Hospital,5000 Monastir, Tunisia
| | - Hechmi Ben Hamouda
- Department of Neonatology, University of Monastir, Tahar Sfar University Hospital, 5111 Mahdia, Tunisia
| | - Sobhi Ghanmi
- Department of Neonatology, University of Monastir, Tahar Sfar University Hospital, 5111 Mahdia, Tunisia
| | - Rim Bouchahda
- Department of Gynecology Obstetric, University of Monastir, Tahar Sfar University Hospital, 5111 Mahdia, Tunisia
| | - Habib Soua
- Department of Neonatology, University of Monastir, Tahar Sfar University Hospital, 5111 Mahdia, Tunisia
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Bhatt S, Tandon A, Kumar Singh A, Manchanda S, Jain S, Meena N. Caudal Regression Syndrome. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2017. [DOI: 10.1177/8756479316677012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Caudal regression syndrome (CRS), also known as caudal dysplasia syndrome, is a rare malformation that ranges from mild coccygeal to severe forms of lumbosacral and lower thoracic agenesis. Anomalies of other organ systems may also be found simultaneously. Recognition of CRS is important as the extent of abnormality and gestational age could determine the pregnancy’s outcome. Antenatal diagnosis is possible by recognizing the characteristic features on sonography. In this particular case study, a diagnosis of CRS was made during the second trimester with sonography and resulted in an adequate medical management decision. The sonographic features of CRS and its differential diagnoses are discussed in the context of this case study.
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Affiliation(s)
- Shuchi Bhatt
- Department of Radiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Anupama Tandon
- Department of Radiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Avneesh Kumar Singh
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandhya Jain
- Department of Obstetrics & Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Neha Meena
- Department of Radiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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Puvabanditsin S, Van Gurp J, February M, Khalil M, Mayne J, Ai McConnell J, Mehta R. VATER/VACTERL Association and Caudal Regression with Xq25-q27.3 Microdeletion: A Case Report. Fetal Pediatr Pathol 2016; 35:133-41. [PMID: 26881326 DOI: 10.3109/15513815.2016.1139019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a term female neonate with vertebral anomalies, anal and urethral atresia, esophageal atresia with tracheoesophageal fistula (TEF), renal agenesis, pulmonary hypoplasia, genital and sacral appendages, and a single umbilical artery. Genetic studies revealed a 20.91 Mb interstitial deletion of the long arm of X chromosome: Xq25-q27.3. This is a new case of VATER/VACTERL association with Xq25 microdeletion.
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Affiliation(s)
- Surasak Puvabanditsin
- a Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick , New Jersey , USA
| | - James Van Gurp
- b Pathology, Rutgers-Robert Wood Johnson Medical School, New Brunswick , New Jersey , USA
| | - Melissa February
- a Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick , New Jersey , USA
| | - Marwa Khalil
- a Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick , New Jersey , USA
| | - Julia Mayne
- a Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick , New Jersey , USA
| | - Jennifer Ai McConnell
- a Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick , New Jersey , USA
| | - Rajeev Mehta
- a Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick , New Jersey , USA
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Abstract
Sirenomelia (mermaid syndrome) is a rare congenital fetal anomaly with characteristic feature of complete or partial fusion of lower limbs. Although, this syndrome is incompatible with life due to the association of several congenital visceral abnormalities; however, there are few reports of surviving infants. Our first case was a live born, normally delivered at term by a 27-year-old third gravida of lower socioeconomic status with history of tobacco use. Examination of the baby revealed caudal dysgenesis having fusion of lower limbs, single leg with 1 foot and 5 toes. There was no identifiable external genitalia and anus. The second case was a 34 week, 1.6 kg preterm infant of unidentified sex born to a 28-year-old primigravida mother with overt diabetes mellitus. Incidentally, both the infants died few hours after birth and we report these cases due to their rarity and term live birth.
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Affiliation(s)
- Sunil Kumar Samal
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Setu Rathod
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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Paoletti D, Robertson M, Sia SB. A sonographic approach to prenatal classification of congenital spine anomalies. Australas J Ultrasound Med 2014; 17:20-37. [PMID: 28191204 PMCID: PMC5024920 DOI: 10.1002/j.2205-0140.2014.tb00081.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective: To develop a classification system for congenital spine anomalies detected by prenatal ultrasound. Methods: Data were collected from fetuses with spine abnormalities diagnosed in our institution over a five-year period between June 2005 and June 2010. The ultrasound images were analysed to determine which features were associated with different congenital spine anomalies. Findings of the prenatal ultrasound images were correlated with other prenatal imaging, post mortem findings, post mortem imaging, neonatal imaging, karyotype, and other genetic workup. Data from published case reports of prenatal diagnosis of rare congenital spine anomalies were analysed to provide a comprehensive work. Results: During the study period, eighteen cases of spine abnormalities were diagnosed in 7819 women. The mean gestational age at diagnosis was 18.8w ± 2.2 SD. While most cases represented open NTD, a spectrum of vertebral abnormalities were diagnosed prenatally. These included hemivertebrae, block vertebrae, cleft or butterfly vertebrae, sacral agenesis, and a lipomeningocele. The most sensitive features for diagnosis of a spine abnormality included flaring of the vertebral arch ossification centres, abnormal spine curvature, and short spine length. While reported findings at the time of diagnosis were often conservative, retrospective analysis revealed good correlation with radiographic imaging. 3D imaging was found to be a valuable tool in many settings. Conclusions: Analysis of the study findings showed prenatal ultrasound allowed detection of disruption to the normal appearances of the fetal spine. Using the three features of flaring of the vertebral arch ossification centres, abnormal spine curvature, and short spine length, an algorithm was devised to aid with the diagnosis of spine anomalies for those who perform and report prenatal ultrasound.
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Affiliation(s)
- Debra Paoletti
- Fetal Medicine Unit Division of Women Youth and Children Canberra Hospital Garran Australian Capital Territory Department of Obstetrics and Gynaecology Australian National University Acton Australian Capital Territory Australia
| | - Meiri Robertson
- Fetal Medicine Unit Division of Women Youth and Children Canberra Hospital Garran Australian Capital Territory Department of Obstetrics and Gynaecology Australian National University Acton Australian Capital Territory Australia
| | - Sock Bee Sia
- Discipline of Medical Radiations School of Medical Sciences RMIT University Melbourne Victoria Australia
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Abstract
Sirenomelia also known as the mermaid syndrome, is a rare congenital malformation of uncertain etiology. It is characterized by fusion of the lower limbs and commonly associated with severe urogenital and gastrointestinal malformations. There are approximately 300 cases reported in the literature, 15% of which are associated with twinning, most often monozygotic. The syndrome of caudal regression is thought to be the result of injury to the caudal mesoderm early in gestation.
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Affiliation(s)
- Vinayak Y Kshirsagar
- Department of Pediatrics, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
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16
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Palacios-Marqués A, Oliver C, Martín-Bayón T, Martinez-Escoriza JC. Prenatal diagnosis of caudal dysplasia sequence associated with undiagnosed type I diabetes. BMJ Case Rep 2013; 2013:bcr-2013-009043. [PMID: 23737573 DOI: 10.1136/bcr-2013-009043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Caudal regression or caudal dysplasia sequence (CDS) is a rare congenital malformation, which includes a wide spectrum of musculoskeletal abnormalities involving the lumbosacral spine, pelvis and lower limbs. It can be associated to visceral defects in various degrees. Maternal diabetes, genetic predisposition and vascular hypoperfusion have been suggested as possible causative factors. Women with diabetes who are dependent on insulin are 200-400 times more likely to have a child with caudal regression, making CDS the most characteristic fetal abnormality of diabetic embryopathy. Prenatal diagnosis is possible by ultrasonographic examination. The sonographic findings include abrupt interruption of the lumbar spine and 'Buddha or frog position' of the lower limbs. MRI has demonstrated the level of the vertebral anomalies as well as the associated abnormalities and this is crucial because the prognosis of this condition depends on the severity of the lesion and the presence of associated disorders.
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Affiliation(s)
- Ana Palacios-Marqués
- Department of Obstetrics and Gynaecology, University General Hospital of Alicante, Alicante, Spain.
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17
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Abstract
Presence of single umbilical persistent vitelline artery distinguishes sirenomelia from caudal regression syndrome. We report a case of a12-year-old boy who had bilateral umbilical arteries presented with fusion of both legs in the lower one third of leg. Both feet were rudimentary. The right foot had a valgus rocker-bottom deformity. All toes were present but rudimentary. The left foot showed absence of all toes. Physical examination showed left tibia vara. The chest evaluation in sitting revealed pigeon chest and elevated right shoulder. Posterior examination of the trunk showed thoracic scoliosis with convexity to right. The patient was operated and at 1 year followup the boy had two separate legs with a good aesthetic and functional results.
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Affiliation(s)
- Sakti Prasad Das
- Department of Physical Medicine and Rehabilitation, SVNIRTAR, Olatpur, Cuttack District, Odisha, India,Address for correspondence: Dr. Sakti Prasad Das, Department of Physical Medicine and Rehabilitation, SVNIRTAR, Olatpur, P.O. Bairoi, Cuttack District, Odisha - 754 010, India. E-mail:
| | - Niranjan Ojha
- Department of Prosthetics and Orthotics, SVNIRTAR, Olatpur, Cuttack District, Odisha, India
| | - G Shankar Ganesh
- Department of Physiotherapy, SVNIRTAR, Olatpur, Cuttack District, Odisha, India
| | - Ram Narayan Mohanty
- Department of Physical Medicine and Rehabilitation, SVNIRTAR, Olatpur, Cuttack District, Odisha, India
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Allache R, De Marco P, Merello E, Capra V, Kibar Z. Role of the planar cell polarity gene CELSR1 in neural tube defects and caudal agenesis. ACTA ACUST UNITED AC 2012; 94:176-81. [PMID: 22371354 DOI: 10.1002/bdra.23002] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/05/2012] [Accepted: 01/10/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Neural tube defects (NTDs), including anencephaly and spina bifida, have a complex etiology. Defects in the planar cell polarity (PCP) signaling pathway have been strongly associated with NTDs in animal models and human cohorts. In this genetic study, we examined the core PCP gene CELSR1 in NTDs and caudal agenesis cases to determine whether mutations at this gene predispose to these defects. METHODS We sequenced the coding region and the exon-intron junctions of CELSR1 in a cohort of 473 patients affected with various forms of open and closed NTDs (412) or caudal agenesis (61). Novel and rare variants (<1%) were genotyped in a cohort of 639 ethnically-matched individuals. The effect of novel missense mutations absent in controls and in public databases on protein function was predicted in silico. RESULTS We identified in our cohort one nonsense mutation in exon 1 of CELSR1 that truncates the majority of the protein in one patient with NTD and one in-frame 12 bp deletion that removes a putative PKC phosphorylation "SSR" motif in one caudal agenesis patient. We also detected a total of 13 novel missense variants in 12 patients (11 NTDs and 1 caudal agenesis) that were predicted to be pathogenic in silico. CONCLUSIONS We detected novel CELSR1 mutations predicted to be pathogenic in 2.9% of our NTD cohort and 3.3% of our caudal agenesis cohort. Our findings implicate CELSR1 as a risk factor for NTDs or caudal agenesis and provide additional evidence for a pathogenic role of PCP signaling in these malformations.
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Affiliation(s)
- Redouane Allache
- Department of Obstetrics and Gynecology, CHU Sainte Justine Research Center and University of Montréal, Montréal, Canada
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Diawara F, Camara M, Thera M, Diallo M, Traore M. Sonographic Diagnosis of Caudal Regression Syndrome. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2009. [DOI: 10.1177/8756479309344623] [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
Caudal regression syndrome is a partial or complete agenesis of the lumbosacral vertebrae. Other abnormalities may be associated, such as polyhydramnios, single umbilical artery, club feet, and renal, gastrointestinal, and genitourinary defects. This report of caudal regression syndrome is about a woman in her mid-20s who was first seen for a routine obstetrical sonogram in her second trimester. Her last menstrual period was unknown. She had no history of diabetes, and her glycemia was normal. Sonographic examination showed a 27-week singleton fetus with polyhydramnios, club feet, multicystic kidneys, sudden termination of the spine at the sacral level, short femurs, a single umbilical artery, and a cystic umbilical cord with excessive Wharton’s jelly. These findings confirmed the diagnosis of caudal regression syndrome. After counseling, the patient elected for termination of the pregnancy and delivered a female fetus with an imperforate anus at 800 grams in weight. Anteroposterior and lateral radiographs of the fetus confirmed the sacral agenesis.
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Ozturk S, Sahin I, Coskun U, Surer I, Sengezer M. Closure of the defect resulting from caudal regression syndrome with duplicated rectum. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 2009; 43:343-345. [PMID: 19995255 DOI: 10.1080/02844310701682923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Caudal regression syndrome covers a range of congenital malformations that range from simple anal atresia to absence of sacral, lumbar, and possibly lower thoracic, vertebrae. To the best of our knowledge, this is the first case of caudal regression syndrome combined with rectal duplication. We present a case and describe our technique of reconstruction.
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Affiliation(s)
- Serdar Ozturk
- Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
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21
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[Sirenomelia as a part of VACTERL association: a study of three cases]. Ann Pathol 2008; 28:176-81. [PMID: 18706355 DOI: 10.1016/j.annpat.2008.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 11/29/2007] [Indexed: 11/20/2022]
Abstract
Sirenomelia, characterized by a fusion of lower limb buds, is rare. Moreover, the coexistence of this malformation with a VACTERL sequence is exceptional. We report, here, three new observations associating these two diseases on fetuses from 14 to 26 weeks gestation. With these three new cases associating sirenomelia and VACTERL, observed in our unit and examined in light of data from the medical literature, we discuss the embryologic origin of such malformations and the nosologic frontiers between these two diseases.
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Vaideeswar P. Combined aortic and inferior vena caval coarctation --an unknown association. Cardiovasc Pathol 2005; 14:269-71. [PMID: 16168901 DOI: 10.1016/j.carpath.2005.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 05/16/2005] [Accepted: 05/17/2005] [Indexed: 11/15/2022] Open
Abstract
Atypical coarctation of the aorta refers to narrowing (discrete or diffuse) that involves the thoracic or abdominal segments. Such a phenomenon has never been reported in the inferior vena cava. This is a report of combined coarctation of the abdominal aorta and inferior caval vein in a still birth with sirenomelia, ambiguous genitalia, and other extracardiac anomalies. The maternal serum was positive for Toxoplasma and CMV. Evidence of phlebitis was present in the inferior caval vein.
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Affiliation(s)
- Pradeep Vaideeswar
- Department of Pathology (Cardiovascular and Thoracic Division), Seth G. S. Medical College, K. E. M. Hospital, Mumbai 400 012, India.
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Singh SK, Singh RD, Sharma A. Caudal regression syndrome--case report and review of literature. Pediatr Surg Int 2005; 21:578-81. [PMID: 15977017 DOI: 10.1007/s00383-005-1451-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2004] [Indexed: 10/25/2022]
Abstract
Caudal regression syndrome is a rare disorder of distal spinal segments affecting the development of the spinal cord, with attendant sequelae. Intelligence is preserved. The exact etiology is elusive, though maternal diabetes, genetic factors, and hypoperfusion might play roles. Recently, the role of teratogens has been studied in animal models. Treatment is difficult, multidisciplinary, and largely supportive. Lower limb deformities with sensory and motor loss and neurogenic bladder call for intensive and long-term attention.
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Affiliation(s)
- Santosh Kumar Singh
- Consultant Pediatric Surgeon, Diplomate of National Board, Tulsi Hospitals Ltd., 1/64 Nawabganj, Kanpur, 208002, India.
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González-Quintero VH, Tolaymat L, Martin D, Romaguera RL, Rodríguez MM, Izquierdo LA. Sonographic diagnosis of caudal regression in the first trimester of pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:1175-1178. [PMID: 12369674 DOI: 10.7863/jum.2002.21.10.1175] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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