1
|
Agrawal N, Prasad S, Manocha D, Malik N. Sirenomelia in Twin Pregnancy: A Case Report. Cureus 2023; 15:e48040. [PMID: 38034197 PMCID: PMC10688234 DOI: 10.7759/cureus.48040] [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: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Sirenomelia is a rare congenital disorder that was once thought to be a severe case of caudal regression but is now thought to be entirely separate. It is often referred to as the "mermaid syndrome" because it causes the lower limbs to atrophy to varying degrees, giving the impression of a mermaid's tail or fin. The syndrome is often viewed as fatal due to the accompanying visceral deformities. Our case was a live born, delivered at term by caesarean section, to a 30-year-old third gravida having twin pregnancy. Examination of the baby revealed caudal dysgenesis with fusion of lower limbs, non-identifiable external genitalia and anus. The infant survived for 11 hours after birth. We report this case due to their rarity and term live birth. While sirenomelia is uncommon, the absence of distinct lower limbs on ultrasonography in the presence of oligo or anhydramnios may prompt consideration of the diagnosis of sirenomelia.
Collapse
Affiliation(s)
- Neha Agrawal
- Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Hospital and Medical College, New Delhi, IND
| | - Sonal Prasad
- Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Hospital and Medical College, New Delhi, IND
| | - Deepika Manocha
- Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Hospital and Medical College, New Delhi, IND
| | - Neeru Malik
- Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Hospital and Medical College, New Delhi, IND
| |
Collapse
|
2
|
Ting Y, Xue-Lan L, Chun-Bao W, Ting Z, Fen L, Zhen H. Dichorionic twin pregnancy with sirenomelia and chromosomal anomaly in 1 fetus: A case report. Medicine (Baltimore) 2021; 100:e24229. [PMID: 33429820 PMCID: PMC7793322 DOI: 10.1097/md.0000000000024229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/17/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Sirenomelia is a rare congenital malformation that threatens fetal survivals. The cases in which twin with sirenomelia and chromosomal abnormality have been seldomly reported. We reported a dichorionic twin case in which one twin had sirenomelia, the other twin had a normal phenotype, and they had different chromosomal abnormalities. PATIENT CONCERNS The abnormal twin was found at 22 weeks by ultrasound. The sirenomelia fetus was complicated with a thoracic stenosis, enlarged rectum without anal opening, the absence of bilateral kidneys, a single umbilical artery, a single lower limb, the abnormal curvature of spine, double outlet of right ventricle, which were the indicatives of the chromosome detection. DIAGNOSIS The copy number variation of the sirenomelia fetus was detected as a deletion of 4.8Mb in 11p11.12-11q11. The co-twin was found with del(Y)(q11.223q11.23), which was as the same as his father's. The mother had normal chromosome. The parents had normal phenotypes. It was firstly reported a microdeletion with sirenomelia fetus. INTERVENTIONS There was no specific treatments for the twins. OUTCOMES Intrauterine death of the sirenomelia fetus was found at 27 weeks and postnatal death after inevitable abortion happened to the co-twin. LESSONS Prenatal ultrasound was responsible for recognizing sirenomelia, and the detailed ultrasound scanning and chromosome detection should be done for the co-twin. The etiology of sirenomelia remains unclear, and genetic detection is also necessary for its pathogenesis research.
Collapse
Affiliation(s)
- Yuan Ting
- Department of Obstetrics & Gynecology
| | | | - Wang Chun-Bao
- Department of Pathology, First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China
| | | | - Li Fen
- Department of Obstetrics & Gynecology
| | - Han Zhen
- Department of Obstetrics & Gynecology
| |
Collapse
|
3
|
Lecoquierre F, Brehin A, Coutant S, Coursimault J, Bazin A, Finck W, Benoist G, Begorre M, Beneteau C, Cailliez D, Chenal P, De Jong M, Degré S, Devisme L, Francannet C, Gérard B, Jeanne C, Joubert M, Journel H, Laurichesse Delmas H, Layet V, Liquier A, Mangione R, Patrier S, Pelluard F, Petit F, Tillouche N, Ravenswaaij‐Arts C, Frebourg T, Saugier‐Veber P, Gruchy N, Nicolas G, Gerard M. Exome sequencing identifies the first genetic determinants of sirenomelia in humans. Hum Mutat 2020; 41:926-933. [DOI: 10.1002/humu.23998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/19/2020] [Accepted: 02/09/2020] [Indexed: 12/25/2022]
Affiliation(s)
- François Lecoquierre
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Anne‐Claire Brehin
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
- Department of FoetopathologyCHU Rouen Rouen France
| | - Sophie Coutant
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Juliette Coursimault
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Anne Bazin
- Département de Génétique et de Biologie SpécialiséeLaboratoire Cerba Saint Ouen l'Aumone France
| | - Wilfrid Finck
- Unité de Foetopathologie, Laboratoire d'anatomie et cytologie pathologiqueCHU Clermont Ferrand Clermont‐Ferrand France
| | - Guillaume Benoist
- Service de gynécologie‐obstétrique et médecine de la reproductionCentre Hospitalier Universitaire de Caen, Universite de Caen Normandie Caen Basse‐Normandie France
| | | | - Claire Beneteau
- Department of Clinical geneticsCHU Hôpital mère et enfant Nantes France
| | | | - Pierre Chenal
- Department of FoetopathologyHopital Monod Le Havre France
| | - Mirjam De Jong
- Department of GeneticsUniversity Medical Centre Groningen, University of Groningen Groningen The Netherlands
| | | | | | - Christine Francannet
- Centre de référence des anomalies malformatives, Service de génétique médicaleCHU Clermont‐Ferrand Clermont‐Ferrand France
- Centre d'Etude des Malformations Congénitales, CEMC‐AuvergneCHU Clermont‐Ferrand Clermont‐Ferrand France
| | - Bénédicte Gérard
- Department of GeneticsCHU de Strasbourg, Hôpital CivilStrasbourg France
| | - Corinne Jeanne
- Department of Foetopathology, Centre François BaclesseCHU Côte de NacreCaen France
| | | | | | - Hélène Laurichesse Delmas
- Centre d'Etude des Malformations Congénitales, CEMC‐AuvergneCHU Clermont‐Ferrand Clermont‐Ferrand France
- Unité de Médecine Fœtale, Service de gynécologie‐obstétriqueCHU Clermont‐FerrandClermont‐Ferrand France
| | - Valérie Layet
- Department of Clinical GeneticsHopital MonodLe Havre France
| | | | - Raphaele Mangione
- Departement of RadiologyPolyclinique Bordeaux Nord‐AquitaineBordeaux France
| | | | - Fanny Pelluard
- Service d'Anatomie‐Cytologie PathologiqueCentre Hospitalier Universitaire de BordeauxBordeaux France
- INSERM UMR1053, Bordeaux Research in Translational Oncology, BaRITOnUniversité de Bordeaux Bordeaux France
| | - Florence Petit
- Clinique de Génétique “Guy Fontaine”—Centre de référence CLAD, Hôpital Jeanne de FlandreCHU LilleLille France
| | - Nadia Tillouche
- Pôle Femme‐Mère‐Nouveau‐néCentre Hospitalier de ValenciennesValenciennes France
| | - Conny Ravenswaaij‐Arts
- Department of GeneticsUniversity Medical Centre Groningen, University of Groningen Groningen The Netherlands
| | - Thierry Frebourg
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Pascale Saugier‐Veber
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Nicolas Gruchy
- Department of Genetics, Normandy Center for Genomic and Personalized MedicineCaen University HospitalCaen France
| | - Gaël Nicolas
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Marion Gerard
- Department of Genetics, Normandy Center for Genomic and Personalized MedicineCaen University HospitalCaen France
| |
Collapse
|
4
|
Abstract
RATIONALE Sirenomelia is a very rare congenital malformation and characterized by fused lower extremities, oligohydramnios, renal agenesis, absent urinary tract and external genitalia, single umbilical artery, and imperforate anus. Ultrasonography is an optimal method for prenatal screening and diagnosis of sirenomelia. The incidence of sirenomelia in the twin pregnancy is extremely low. PATIENT CONCERNS We reported a case of 1 twin with sirenomelia in dichorionic-diamniotic twin pregnancy after in vitro fertilization and embryo transfer. DIAGNOSES The sirenomelia twin was diagnosed at the 2nd trimester by ultrasonic examination and complicated with oligohydramnios and a single umbilical artery, another twin was normal. INTERVENTIONS A regular and careful antenatal care was conducted. The parents refused to examine the chromosome of sirenomelia twin, and the chromosomal microarray analysis of the amniotic fluid sample was only achieved in the normal anatomy twin after extensively counseled by the multi-disciplinary team. OUTCOMES At 34+2 gestational weeks, the demise of the malformed twin occurred, while fetal heart rate monitoring of the normal twin was abnormal, and an emergency cesarean section was performed. A healthy male baby was delivered with Apgar scores of 10 and 10 at 1 and 5 minutes, respectively. The mother and the baby were followed up and are in good health until now. CONCLUSION Sirenomelia is a lethal condition in the perinatal period. Early antenatal diagnosis is very important. Voluntary selective termination of sirenomelia 1 in twin pregnancy may be advised. Expecting parents should be counseled by the multidisciplinary team about the management and prognosis of the sirenomelia.
Collapse
Affiliation(s)
- Tingting Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan
| | - Hong Luo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan
- Department of Ultrasonic Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan
| |
Collapse
|
5
|
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
|
6
|
Nokeaingtong K, Kaewchai S, Visrutaratna P, Khuwuthyakorn V. Sirenomelia type VI (sympus apus) in one of dizygotic twins at Chiang Mai University Hospital. BMJ Case Rep 2015; 2015:bcr-2014-208501. [PMID: 25976191 DOI: 10.1136/bcr-2014-208501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Those born with sirenomelia, a rare congenital anomaly, have features resembling a mermaid. Characteristics of sirenomelia are a single lower limb, sacral and pelvic bone defects, and anorectal and urogenital malformations. There is an increased incidence of sirenomelia in males and twins. This case was a preterm male, dizygotic twin and product of in vitro fertilisation. The baby was born by caesarean section due to breech presentation. He was found to have a fused lower extremity and absent external genitalia and anus. The baby passed away shortly after birth due to severe respiratory failure. Radiographic findings showed small lung volume and pneumothoraces. There were multiple segmental fusions of the vertebrae. Single femur and single tibia were presented in a fused lower limb. Autopsy demonstrated large intestinal atresia, intra-abdominal testes, absence of kidney, ureter and bladder, single umbilical artery, agenesis of blood vessels at lower extremity and agenesis of sacrum and coccyx.
Collapse
Affiliation(s)
| | - Sirirat Kaewchai
- Department of Pathology, Anatomical Pathology, Chiang Mai University, Chiang Mai, Thailand
| | | | | |
Collapse
|
7
|
Lhuaire M, Jestin A, Boulagnon C, Loock M, Doco-Fenzy M, Gaillard D, Diebold MD, Avisse C, Labrousse M. Sirenomelia: a new type, showing VACTERL association with Thomas syndrome and a review of literature. ACTA ACUST UNITED AC 2013; 97:123-32. [PMID: 23526679 DOI: 10.1002/bdra.23125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/04/2013] [Accepted: 02/07/2013] [Indexed: 11/10/2022]
Abstract
Sirenomelia or "mermaid syndrome" is a rare congenital anomaly known since antiquity. This congenital anomaly is defined as a polymalformative syndrome that associates major muscle and skeleton abnormalities (unique lower limbs) with visceral abnormalities (unilateral or bilateral renal agenesis, anomalies of the abdominal vascularisation). This phenotype, typical of sirenomelia syndrome, may be more or less severe. The pathogenic mechanisms of this syndrome are still debated and its etiology remains unknown. We report here a new type of sirenomelia that we observed in a fetus belonging to the collection of the Department of Anatomy of Reims, which led us to perform a comprehensive review of the literature on the subject: this type has never been reported and cannot be classified according to the Stocker and Heifetz classification. Moreover, this case also presents a VACTERL association with Thomas syndrome.
Collapse
Affiliation(s)
- Martin Lhuaire
- Department of Anatomy, Faculté de Médecine de Reims, Université de Reims Champagne-Ardenne, Reims, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Sirenomelia: a review on embryogenic enviromental theories, novel three-dimensional ultrasound imaging and first trimester diagnosis in a case of mosaic 69,XXX/46,XX fetus. Arch Gynecol Obstet 2013; 288:3-11. [PMID: 23625330 DOI: 10.1007/s00404-013-2847-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Sirenomelia is caused by atrophy of the lower extremities that is commonly associated with gastrointestinal and urogenital malformations. METHODS Embryogenic environmental theories and systematic review of the literature are reported. RESULTS Genetic basis of the condition has been demonstrated in the animal model. In humans, association with de novo balanced translocation has only recently been documented. CONCLUSIONS A case of triploidy mosaic fetus with sirenomelia and posterior fossa anomaly diagnosed at first trimester using novel three-dimensional ultrasound imaging techniques is presented.
Collapse
|
9
|
Chen CP, Hsu CY, Lee MS, Liu YP, Tsai FJ, Wu PC, Chern SR, Wang W. Magnetic resonance imaging demonstration of sirenomelia in one fetus of a dizygotic twin pregnancy conceived by intracytoplasmic sperm injection, in vitro fertilization and embryo transfer. Taiwan J Obstet Gynecol 2012; 50:561-3. [PMID: 22212341 DOI: 10.1016/j.tjog.2011.10.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2010] [Indexed: 11/30/2022] Open
|
10
|
Abstract
Sirenomelia is a rare congenital malformative disorder characterized by fusion of the lower limbs giving a characteristic mermaid-like appearance to the affected foetus. We report a case of sirenomelia occurring in a 19 year old Cameroonian woman following premature rupture of membranes and associated cord prolapse. This is the first documented case in this country. We highlight some of the cultural myths associated with this disorder and discuss our findings relative to the present literature and related controversies on its etiopathogenesis.
Collapse
Affiliation(s)
- Frederick Li Morfaw
- Department of Obstetrics and Gynaecology, Faculty of Medicines and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Philip N Nana
- Department of Obstetrics and Gynaecology, Faculty of Medicines and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| |
Collapse
|
11
|
Orioli IM, Amar E, Arteaga-Vazquez J, Bakker MK, Bianca S, Botto LD, Clementi M, Correa A, Csaky-Szunyogh M, Leoncini E, Li Z, López-Camelo JS, Lowry RB, Marengo L, Martínez-Frías ML, Mastroiacovo P, Morgan M, Pierini A, Ritvanen A, Scarano G, Szabova E, Castilla EE. Sirenomelia: an epidemiologic study in a large dataset from the International Clearinghouse of Birth Defects Surveillance and Research, and literature review. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2011; 157C:358-73. [PMID: 22002878 DOI: 10.1002/ajmg.c.30324] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sirenomelia is a very rare limb anomaly in which the normally paired lower limbs are replaced by a single midline limb. This study describes the prevalence, associated malformations, and maternal characteristics among cases with sirenomelia. Data originated from 19 birth defect surveillance system members of the International Clearinghouse for Birth Defects Surveillance and Research, and were reported according to a single pre-established protocol. Cases were clinically evaluated locally and reviewed centrally. A total of 249 cases with sirenomelia were identified among 25,290,172 births, for a prevalence of 0.98 per 100,000, with higher prevalence in the Mexican registry. An increase of sirenomelia prevalence with maternal age less than 20 years was statistically significant. The proportion of twinning was 9%, higher than the 1% expected. Sex was ambiguous in 47% of cases, and no different from expectation in the rest. The proportion of cases born alive, premature, and weighting less than 2,500 g were 47%, 71.2%, and 88.2%, respectively. Half of the cases with sirenomelia also presented with genital, large bowel, and urinary defects. About 10-15% of the cases had lower spinal column defects, single or anomalous umbilical artery, upper limb, cardiac, and central nervous system defects. There was a greater than expected association of sirenomelia with other very rare defects such as bladder exstrophy, cyclopia/holoprosencephaly, and acardia-acephalus. The application of the new biological network analysis approach, including molecular results, to these associated very rare diseases is suggested for future studies.
Collapse
Affiliation(s)
- Iêda M Orioli
- Estudo Colaborativo Latino Americano de Malformações Congênitas at Departamento de Genética, Instituto de Biologia, Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Fadhlaoui A, Khrouf M, Gaigi S, Zhioua F, Chaker A. The sirenomelia sequence: a case history. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2010; 3:41-9. [PMID: 21769253 PMCID: PMC3046016 DOI: 10.4137/ccrep.s5347] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of sirenomelia sequence observed in an incident of preterm labor during the 29th gestational week. According to some authors, this syndrome should be classified separately from caudal regression syndrome and is likely to be the result of an abnormality taking place during the fourth gestational week, causing developmental abnormalities in the lower extremities, pelvis, genitalia, urinary tract and digestive organs. Despite recent progress in pathology, the etiopathogenesis of sirenomelia is still debated.
Collapse
Affiliation(s)
- Anis Fadhlaoui
- Department of Gynecology and Obstetrics, Aziza Othmana Hospital, Place du Gouvernement, La Kasba, Tunis, Tunisia
| | | | | | | | | |
Collapse
|
13
|
Taghavi MM, Jafari Naveh HR, Shariati M, Morteza Zade F. Sirenomelia (mermaid syndrome): an infant from parents who used a special form of snuff. Pak J Biol Sci 2009; 12:722-5. [PMID: 19634478 DOI: 10.3923/pjbs.2009.722.725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report the first case of a fetus with sirenomelia or mermaid syndrome, whose Afghanian parents were heavy user of a special form of snuff. The case was diagnosed as a mermaid syndrome but some of the features were common to both symmelia dipus and symmelia apus, for example, the single lower extremity had the normal femur, tibia and fibula, but the single foot was rotated medially. The digestive tube ended to a massive closed saclike structure and the anus was absence. The external genital organs were rudiment and the normal testes were undescended. Aorta was divided to branches, such that the external iliac arteries were very small in comparison to the internal iliac arteries. Inferior Vena cava was placed on to the left side of the aorta and unlike the majority of reported mermaid syndrome, the bladder was present. So, the researchers believe that the present case is a rare variant of the mermaid syndrome.
Collapse
Affiliation(s)
- M M Taghavi
- Department of Anatomy, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | | | | | | |
Collapse
|
14
|
Jakobovits A. [Fetal bone and joint disorders]. Orv Hetil 2008; 149:2425-31. [PMID: 19073454 DOI: 10.1556/oh.2008.28499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The article discusses the physiology and pathology of fetal bone and joint development and functions. The bones provide static support for the body. The skull and the bones of spinal column encase the central and part of the peripheral nervous system. The ribs and the sternum shield the heart and the lungs, while the bones of the pelvis protect the intraabdominal organs. Pathological changes of these bony structures may impair the functions of the respective systems or internal organs. Movements of the bones are brought about by muscles. The deriving motions are facilitated by joints. Bony anomalies of the extremities limit their effective functions. Apart from skeletal and joint abnormalities, akinesia may also be caused by neurological, muscular and skin diseases that secondarily affect the functions of bones and joints. Such pathological changes may lead to various degrees of physical disability and even to death. Some of the mentioned anomalies are recognizable in utero by ultrasound. The diagnosis may serve as medical indication for abortion in those instances when the identified abnormality is incompatible with independent life.
Collapse
Affiliation(s)
- Akos Jakobovits
- Toldy Ferenc Kórház Szülészeti és Nogyógyászati Osztály Cegléd Pf. 63. 2700.
| |
Collapse
|
15
|
Lachman RS. S. TAYBI AND LACHMAN'S RADIOLOGY OF SYNDROMES, METABOLIC DISORDERS AND SKELETAL DYSPLASIAS 2007. [PMCID: PMC7315357 DOI: 10.1016/b978-0-323-01931-6.50027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Nisenblat V, Leibovitz Z, Paz B, Shapiro I, Degani S, Ohel G. Dizygotic twin pregnancy discordant for sirenomelia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:97-103. [PMID: 17182714 DOI: 10.7863/jum.2007.26.1.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Vicki Nisenblat
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | | | | | | | | | | |
Collapse
|
17
|
Messineo A, Innocenti M, Gelli R, Pancani S, Lo Piccolo R, Martin A. Multidisciplinary surgical approach to a surviving infant with sirenomelia. Pediatrics 2006; 118:e220-3. [PMID: 16801393 DOI: 10.1542/peds.2005-3001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sirenomelia is an extremely complex and rare malformation with different degrees of lower-extremities fusion associated with gastrointestinal, musculoskeletal, vascular, cardiopulmonary, and central nervous system malformations. In the English literature, there are only 5 reports of infants surviving with this condition. In our case, a 2540-g female infant was born with normal vital signs, no facial dysmorphism, and a complete soft tissue fusion of the lower limbs, from perineum to ankles. Radiologic examinations revealed an intestinal atresia and a single pelvic kidney, with a unique ureter, 2 femurs, 2 tibias, 2 fibulas, and 2 feet (simpus dipus). At 7 months of age, a multidisciplinary surgical team achieved complete separation of the lower limbs, with independent vascular and nerve supplies. At the time of this writing, the infant was 28 months old and had a regular growth curve. Many future reconstructive surgeries have been planned to achieve an acceptable quality of life for this infant.
Collapse
Affiliation(s)
- Antonio Messineo
- Department of Pediatric Surgery and Burn Unit, Anna Meyer Children's Hospital, Via Luca Giordano 13, 50132 Florence, Italy.
| | | | | | | | | | | |
Collapse
|
18
|
Romano S, Esposito V, Fonda C, Russo A, Grassi R. Beyond the myth: the mermaid syndrome from Homerus to Andersen. A tribute to Hans Christian Andersen's bicentennial of birth. Eur J Radiol 2006; 58:252-9. [PMID: 16423484 DOI: 10.1016/j.ejrad.2005.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 12/13/2005] [Indexed: 11/25/2022]
Abstract
Mermaid or sirens have been part of the cultural tradition of the sailors during the first expeditions in the western world. The Siren's Myth appeared for a first time with Homer, who described in the Odyssey some singing creatures that lured the enchanted sailors to death. More frequently described with a bird body and a female head, sometimes the female part was extended to torso, with arms prolonged in sturdy claws. In the Latin literature Publius Ovidius Naso presented in the Métamorphoses these creatures. Proposed ethymology for the word "siren" seems to confirm the prerogatives of these creatures, related to magnetism, seduction, charm. The first figuration of Sirens resembling to fish-women was in the second century bc. Hans Christian Andersen provided to leave us the strongest legend of Siren in the well-known fairy tale "The Little Mermaid". Following this story, Sirens are definitely considered as beautiful half-fish women who lived in the bottom of the sea, having a lovely voice to be used when they rise up to allow sweeter the agony of the wrecked sailors. Beyond the Myth, may the Siren really exist? It can be hypothesized that these creatures probably were individuals affected by sirenomelia. In our literature and medical review, we describe the etiology of the disease, and we illustrated the anatomical features of fetuses affected by this pathology using MDCT 3D reconstructions. Syrenomelia is a condition not compatible with the normal life, however nine cases of "mermaid" survived to reconstructive surgery have been reported until now. In our report we also presented a case of survival baby girl affected by sirenomelia, before and after surgery, with correlative radiologic imaging findings. The most important characteristic that seems to allow survival of the affected individuals is the presence of one functional kidney, displaced in pelvis. As so dramatically tragic was the history of the Andersen Little Mermaid, so unattended pleasant would be the destiny of a modern mermaid, who can hope to finally marry her prince, without the risk to "loose her head", as the Copenhagen City's Symbol did in the past years, for a story beyond the Myth.
Collapse
Affiliation(s)
- Stefania Romano
- Department of Diagnostic Imaging, "A. Cardarelli" Hospital, Viale Cardarelli 9, 80131 Naples, Italy.
| | | | | | | | | |
Collapse
|
19
|
Horikoshi T, Kikuchi A, Tatematsu M, Matsumoto Y, Hayashi A, Unno N. Two cases of a fetus with sirenomelia sequence. Congenit Anom (Kyoto) 2005; 45:93-5. [PMID: 16131367 DOI: 10.1111/j.1741-4520.2005.00074.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report two cases of a fetus with sirenomelia sequence which showed oligohydramnios and a single umbilical artery. The first case was of a single fetus with symelia apus and only one leg. Prenatal diagnosis of this case was possible. The second case was of a dichorionic-diamniotic twin pregnancy in which one fetus had symelia dipus with two fused lower extremities. Prenatal diagnosis of the condition was not made. In both cases, the fetuses died shortly after birth from respiratory distress due to severe pulmonary hypoplasia. Absence of urinary tract, imperforate anus, and spine deformity were confirmed in both cases. Although prenatal diagnosis of symelia dipus seems difficult, this condition must be considered in a fetus with severe oligohydramnios.
Collapse
Affiliation(s)
- Tsuguhiro Horikoshi
- Department of Obstetrics, Center for Perinatal Medicine, Nagano Children's Hospital, Toyoshina, Nagano, Japan
| | | | | | | | | | | |
Collapse
|
20
|
Dorenbeck U, Schreyer AG, Plendl PJ, Hees H, Feuerbach S, Held P. Magnetic resonance imaging, computed tomography, and conventional X-ray in 3 cases of symmelia. ACTA ACUST UNITED AC 2005; 73:628-33. [PMID: 16007588 DOI: 10.1002/bdra.20171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Symmelia is a rare birth defect, often combined with severe malformations of the urogenital system and the lower gastrointestinal tract. Additionally, a deformed pelvis and various degrees of separation of the lower limbs are present. CASES We report the examination findings of 3 autopsy specimens of symmelia using magnetic resonance imaging (MRI) and computed tomography (CT) with 3-dimensional (3D) reconstructions, and conventional X-ray. CONCLUSIONS MRI and CT with the addition of 3D visualization can be used additionally with autopsy and conventional X-ray images in the investigation of such complex anatomical abnormalities.
Collapse
Affiliation(s)
- Ulrich Dorenbeck
- Department of Diagnostic Radiology University Hospital of Regensburg, Regensburg, Germany.
| | | | | | | | | | | |
Collapse
|
21
|
Lutz N, Meyrat BJ, Guignard JP, Hohlfeld J. Mermaid syndrome: virtually no hope for survival. Pediatr Surg Int 2004; 20:559-61. [PMID: 15221362 DOI: 10.1007/s00383-003-0992-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2002] [Indexed: 10/26/2022]
Abstract
Sirenomelia, also called the mermaid syndrome is a severe malformation involving multiple organs and characterized by partially or completely developed lower extremities fused by the skin. The birth of a "mermaid" is very rare (1.2-4.2 cases for 100,000 births); most are stillborn, or die at or shortly after birth. The case of a living female neonate with dipodic simelia (fusion of well-developed legs) is presented. No prenatal diagnosis was made and the newborn had an uneventful neonatal course following Cesarean section delivery. The complex and striking malformation was obvious at birth and further evaluation revealed very poorly functioning kidneys, associated with abnormal anorectum, urogenital tract, and external genitalia, as well as a pelvic malformation. Supportive care was applied because of the poor prognosis and the child died at 7 weeks of age, due to renal failure.
Collapse
Affiliation(s)
- Nicolas Lutz
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland.
| | | | | | | |
Collapse
|
22
|
Affiliation(s)
- F Jaiyesimi
- Departments of Pediatrics, and Radiology, Buraimi Hospital, Sultanate of Oman
| | | | | | | |
Collapse
|
23
|
Abstract
Sirenomelia, or mermaid syndrome, is the extreme form of caudal regression syndrome. We present another case of this fascinating anomaly with fused lower limbs, absent external genitalia, and absent genitourinary system. The patient could not be salvaged because of bilateral renal agenesis. Detailed autopsy findings and a review of the literature are presented.
Collapse
|
24
|
McCoy MC, Chescheir NC, Kuller JA, Altman GC, Flannagan LM. A fetus with sirenomelia, omphalocele, and meningomyelocele, but normal kidneys. TERATOLOGY 1994; 50:168-71. [PMID: 7801305 DOI: 10.1002/tera.1420500212] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Sirenomelia, which has been reported for more than 450 years, is the most severe form of caudal dysplasia. This disorder is classically associated with agenesis or severe dysplasia of the urinary tract. A 27-year-old gravida 3 para 0020 presented at 19 weeks' gestation with monoamniotic twins, one normal and one with sirenomelia. The pregnancy miscarried following invasive diagnostic testing. Autopsy confirmed the findings of sirenomelia, meningomyelocele, omphalocele, persistent cloaca, and two normal kidneys. The abnormalities accompanying sirenomelia appear as a spectrum. The pathogenic theories of sirenomelia are reviewed in light of this case with normal kidneys.
Collapse
Affiliation(s)
- M C McCoy
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill 27599-7570
| | | | | | | | | |
Collapse
|