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Hakimi T, Ibrahimi MA. A rare case report of prune belly syndrome with malnutrition. Oxf Med Case Reports 2021; 2021:omab017. [PMID: 33948190 PMCID: PMC8081022 DOI: 10.1093/omcr/omab017] [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: 08/05/2020] [Revised: 11/30/2020] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
Prune belly syndrome (PBS) is a rare congenital malformation of unknown etiology characterized by a triad of deficient abdominal wall musculature, undescended testicles and urinary tract malformations. Most of the patients have pulmonary, cardiac, skeletal and gastrointestinal tract anomalies. Lack of abdominal muscles leads to constipation due to inability to perform Valsalva maneuver, which helps push the stool out of the rectum during the defecation. Additionally, frequent respiratory tract infections, persisting constipation and urinary tract infections lead to the development of malnutrition in children. We report this case to raise the awareness of low socioeconomic and low-resource medical settings that malnutrition could be existed or caused by PBS. We also encourage the expansion of pediatric surgery and family medicine training to increase the number of specialist (family medicine) to report and refer PBS in earlier phase, while working in rural areas and remote provinces.
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Affiliation(s)
- Turyalai Hakimi
- Department of Pediatric Surgery, Kabul University of Medical Science, Maiwand University Hospital, Kabul, Afghanistan
| | - Mohammad Akbar Ibrahimi
- Department of Pediatric Internal Disease, Kabul University of Medical Science, Maiwand University Hospital, Kabul, Afghanistan
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Wong DG, Arevalo MK, Passoni NM, Iqbal NS, Jascur T, Kern AJ, Sanchez EJ, Satyanarayan A, Gattineni J, Baker LA. Phenotypic severity scoring system and categorisation for prune belly syndrome: application to a pilot cohort of 50 living patients. BJU Int 2019; 123:130-139. [PMID: 30113772 PMCID: PMC7368761 DOI: 10.1111/bju.14524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To design a novel system of scoring prune belly syndrome (PBS) phenotypic severity at any presenting age and apply it to a large pilot cohort. PATIENTS AND METHODS From 2000 to 2017, patients with PBS were recruited to our prospective PBS study and medical records were cross-sectionally analysed, generating individualised RUBACE scores. We designed the pragmatic RUBACE-scoring system based on six sub-scores (R: renal, U: ureter, B: bladder/outlet, A: abdominal wall, C: cryptorchidism, E: extra-genitourinary, generating the acronym RUBACE), yielding a potential summed score of 0-31. The 'E' score was used to segregate syndromic PBS and PBS-plus variants. The cohort was scored per classic Woodard criteria and RUBACE scores compared to Woodard category. RESULTS In all, 48 males and two females had a mean (range) RUBACE score of 13.8 (8-25) at a mean age of 7.3 years. Segregated by phenotypic categories, there were 39 isolated PBS (76%), six syndromic PBS (12%) and five PBS-plus (10%) cases. The mean RUBACE scores for Woodard categories 1, 2, and 3 were 20.5 (eight patients), 13.8 (25), and 10.6 (17), respectively (P < 0.001). CONCLUSIONS RUBACE is a practical, organ/system level, phenotyping tool designed to grade PBS severity and categorise patients into isolated PBS, syndromic PBS, and PBS-plus groups. This standardised system will facilitate genotype-phenotype correlations and future prospective multicentre studies assessing medical and surgical treatment outcomes.
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Affiliation(s)
- DG Wong
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - MK Arevalo
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - NM Passoni
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
- Pediatric Urology, Children’s Health Dallas, 2350 N. Stemmons Freeway, Suite F4300, Dallas, TX 75207, USA
| | - NS Iqbal
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - T Jascur
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - AJ Kern
- Pediatric Urology, Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD 21401, USA
| | - EJ Sanchez
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
- Pediatric Urology, Children’s Health Dallas, 2350 N. Stemmons Freeway, Suite F4300, Dallas, TX 75207, USA
| | - A Satyanarayan
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
- Pediatric Urology, Children’s Health Dallas, 2350 N. Stemmons Freeway, Suite F4300, Dallas, TX 75207, USA
| | - J Gattineni
- Pediatric Nephrology, Children’s Health Dallas, 1935 Medical District Dr, Suite B5238, Dallas, TX 75235, USA
| | - LA Baker
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
- Pediatric Urology, Children’s Health Dallas, 2350 N. Stemmons Freeway, Suite F4300, Dallas, TX 75207, USA
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Valappil B, Krishna L, Sreedharan R, Shetty A. Exploration of the fetus with gross anomaly: a case of pseudo prune belly syndrome. Anat Cell Biol 2018; 51:205-208. [PMID: 30310713 PMCID: PMC6172593 DOI: 10.5115/acb.2018.51.3.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/08/2018] [Accepted: 03/19/2018] [Indexed: 11/27/2022] Open
Abstract
Prune belly syndrome is a rare congenital anomaly usually presented with triad characteristic feature of deficient abdominal muscles, cryptorchidism, and urinary tract anomalies. Here, we present a case with all the characteristic features of prune belly and the associated secondary features which were observed on detailed dissection and exploration of the fetus.
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Affiliation(s)
- Bhagyam Valappil
- Department of Anatomy, Jubilee Mission Medical College and Research Institute, Thrissur, India
| | - Lalu Krishna
- Department of Anatomy, Jubilee Mission Medical College and Research Institute, Thrissur, India
| | - Ranjith Sreedharan
- Department of Anatomy, Jubilee Mission Medical College and Research Institute, Thrissur, India
| | - Ashwija Shetty
- Department of Anatomy, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Grover H, Sethi S, Garg J, Ahluwalia AP. Pseudo Prune Belly Syndrome: Diagnosis Revealed by Imaging - A Case Report and Brief Review. Pol J Radiol 2017; 82:252-257. [PMID: 28580040 PMCID: PMC5436412 DOI: 10.12659/pjr.899743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/13/2016] [Indexed: 11/14/2022] Open
Abstract
Background Prune Belly Syndrome (PBS) is a rare entity, usually found in male neonates. It comprises complex urinary tract anomalies, bilateral undescended testis and absence of anterior abdominal wall muscles. Patients with unilateral abdominal wall deficiency, unilateral undescended testis and female neonates with abdominal wall laxity are classified as Pseudo Prune Belly syndrome (PPBS). Reports on PPBS do not highlight the radiological and imaging characteristics of this syndrome and the current literature on the role of newer imaging modalities, such as Magnetic Resonance Imaging (MRI), remains relatively sparse. We describe a new case of PPBS and emphasize the role of imaging, especially ultrasound and MRI in the process of diagnosis and briefly review the subject. Case Report A male infant of four months of age was referred for evaluation of left-sided cryptorchidism. Clinical examination revealed laxity of the left abdominal wall. Ultrasound examination of the abdomen, pelvis and scrotum was performed together with routine laboratory tests. Ultrasound examination was followed by intravenous urography, voiding cysto-urethrography and MRI of the abdomen. On ultrasound, the left testis was located in the inguinal canal, the right kidney was slightly enlarged and the left kidney could not be localized. Ultrasound appearances suggested chronic obstruction in the urinary bladder. Intravenous urography, voiding cysto-urethrography and MRI confirmed the ultrasound diagnosis and also revealed a left dysplastic kidney with a dilated, tortuous ureter. Clinical and imaging features were consistent with pseudo prune belly syndrome (PPBS). Conclusions We report a new occurrence of PPBS, a rare entity. The imaging approach for a comprehensive evaluation of the renal system in PPBS, especially with MRI, is emphasized.
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Affiliation(s)
- Hemal Grover
- At the time of study: Postgraduate Resident, Department of Radiology and Imaging, Government Medical College and Rajindra Hospital, Patiala, Punjab, India; Currently, Department of Neuro-Radiology, New York Medical University, New York, NY, U.S.A
| | - Sanjay Sethi
- Department of Radiology and Imaging, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Jatin Garg
- Dexa Scan Centre, Patiala, Punjab, India
| | - Amrit Pal Ahluwalia
- Department of Radiology and Imaging, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
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Awad K, Lall A. It's not All Doom and Gloom: Prune Belly Syndrome Associated with VACTERL. J Neonatal Surg 2016; 5:33. [PMID: 27433451 PMCID: PMC4942433 DOI: 10.21699/jns.v5i3.337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/20/2016] [Indexed: 11/16/2022] Open
Abstract
Prune belly syndrome is a rare abnormality; its association with VACTERL is even rarer. This association has been reported in literature a few times since first reported in 1993 and so far the majority have either been stillbirths or died shortly after birth. We present a case of Prune belly syndrome associated with VACTERL who is now one year old.
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Affiliation(s)
- Karim Awad
- Department of Paediatric Surgery, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne, UK ; Ain Shams University Hospitals, Egypt
| | - Anupam Lall
- Department of Paediatric Surgery, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne, UK
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