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Narayan R, Meena A, Sarkar R, Agrawal M. A Rare Case Report of Limb Body Wall Complex. Cureus 2024; 16:e59026. [PMID: 38800175 PMCID: PMC11127772 DOI: 10.7759/cureus.59026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Limb body wall complex (LBWC), also known as body stalk anomaly, is a rare and lethal disorder of the anterior abdominal wall. It is characterized by a severe combination of congenital malformations in the fetus, including, abdomino- and/or thoracoschisis, exencephaly/encephalocele, limb deformities, and facial clefts. Short umbilical cord, abdominal placental attachment, and spinal anomalies are among other manifestations of this disorder. The cause of LBWC is still unknown. The main hypotheses include embryonic dysplasia, early amniotic rupture, and vascular accident during embryonic development. We present a case of LBWC that was detected prenatally on ultrasound (USG) imaging and later confirmed postnatally in a Rh-negative mother at the menstrual age of 14 weeks.
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Affiliation(s)
- Ruchika Narayan
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, IND
| | - Anamika Meena
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, IND
| | - Rajib Sarkar
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, IND
| | - Muskaan Agrawal
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, IND
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2
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Ye CH, Li S, Ling L. Analysis of characteristic features in ultrasound diagnosis of fetal limb body wall complex during 11-13 +6 weeks. World J Clin Cases 2023; 11:4544-4552. [PMID: 37469738 PMCID: PMC10353514 DOI: 10.12998/wjcc.v11.i19.4544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Limb body wall complex (LBWC) is a fatal malformation characterized by major defects in the fetal abdominal or thoracic wall, visceral herniation, significant scoliosis or spina bifida, limb deformities, craniofacial deformities, and umbilical cord abnormalities (short or absent umbilical cord). Early diagnosis of this condition is of great clinical significance for clinical intervention and pregnancy decision-making. With the rapid development of fetal ultrasound medicine, early pregnancy (11-13+6 wk) standardized prenatal ultrasound examinations have been widely promoted and applied.
AIM To explore the value of prenatal ultrasound in the diagnosis of fetal LBWC syndrome during early pregnancy.
METHODS The ultrasonographic data and follow-up results of 18 cases of fetal LBWC diagnosed by prenatal ultrasound during early pregnancy (11-13+6 wk) were retrospectively analyzed, and their ultrasonographic characteristics were analyzed.
RESULTS Among the 18 fetuses with limb wall abnormalities, there were spinal dysplasia (18/18, 100%), varying degrees of thoracoschisis and gastroschisis (18/18, 100%), limb dysplasia in 6 cases (6/18, 33%), craniocerebral malformations in 4 cases (4/18, 22%), thickening of the transparent layer of the neck in 5 cases (5/18, 28%), and umbilical cord abnormalities in 18 cases (18/18, 100%), single umbilical artery in 5 cases.
CONCLUSION Prenatal ultrasound in early pregnancy can detect LBWC as early as possible, and correct prenatal evaluation provides important guidance value for pregnancy decision-making and early intervention.
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Affiliation(s)
- Cai-Hong Ye
- Department of Ultrasound, Yijishan Hospital Wannan Medical College, Wuhu 241001, Anhui Province, China
| | - Shuo Li
- Department of Ultrasound, Wannan Medical College, Wuhu 241001, Anhui Province, China
| | - Li Ling
- Department of Obstetrics, Wannan Medical College, Wuhu 241001, Anhui Province, China
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Farias MG, Cucolicchio N, Bueno De Vuono AP, Ferreira de Sousa R, Dutra do Valle MR, Traballi de Carvalho Pegolo P, Cunha SC, Eid FB, Duarte Nogueira RM, de Carvalho R, Bustorff-Silva J. Isolated thoracoschisis with multi-organ herniation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Martín-Alguacil N. Anatomy-based diagnostic criteria for complex body wall anomalies (CBWA). Mol Genet Genomic Med 2020; 8:e1465. [PMID: 32856427 PMCID: PMC7549580 DOI: 10.1002/mgg3.1465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/11/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Precise diagnosis and classification of CBWA cases can be challenging. BSA are considered when there is a body wall anomaly, skeletal abnormalities, and the umbilical cord is anomalous, absent or rudimentary, and LBWC when there is a body wall and structural limb anomalies with or without craniofacial abnormalities. METHODS PubMed was searched for body stalk anomalies, limb body wall complex, body stalk anomalies and amniotic band syndrome, and limb body wall complex and amniotic band syndrome. Sixty nine articles were selected and reviewed. This article systematically classifies the variants of CBWA in 218 cases, the study is based on the embryological and anatomical criteria established by Martín-Alguacil and Avedillo to study BSA in the pig. RESULTS Eight different BSA presentation were defined. One hundred and eighty nine cases were classified as BSA, from which five were Type I, nine Type II, 20 Type III, 57 Type IV, 11Type V, 24 Type VI, 11 Type VII, and 52 Type VIII. Twenty six cases presented cranial phenotype, 114 abdominal phenotype, 42 cranio/abdominal overlapping phenotype, and five without defined phenotype. In addition, 52 BSA cases presented some kind of spinal dysraphism (SPDYS) and were classified as BSA/SPDYS, most of these cases did not show structural limb anomalies, except for three cases and were classified as LBWC/SPDYS. CONCLUSION This morphology-based classification represents a useful tool for clinical diagnosis, it helps to quantify and to evaluate CBWA in a precise, objective manner.
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Martín-Alguacil N, Avedillo L. Body stalk anomalies in pig-Definition and classification. Mol Genet Genomic Med 2020; 8:e1227. [PMID: 32281290 PMCID: PMC7284046 DOI: 10.1002/mgg3.1227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/01/2020] [Indexed: 02/06/2023] Open
Abstract
The presence of body wall closing defects (abdominoschisis and thoracoabdominoschisis) in combination with other congenital malformations was studied in the pig (Sus scrofa domesticus). After clinical examination and literature review, body wall defects with multiple congenital anomalies in eight pigs were described, and classified using anatomical and embryological criteria. Several BSA presentations were identified and classified as follows: (a) BSA Type I: fetus with spinal and UC defects, thoracoabdominoschisis, anal atresia and/or other internal organs structural defects, and structural limb defects; (b) BSA Type II: fetus with spinal and UC defects, thoracoabdominoschisis, anal atresia and/or other internal organs structural defects, and nonstructural limb defects; (c) BSA Type III: fetus with spinal and UC defects, abdominoschisis, anal atresia and/or other internal organs structural defects, and structural limb defects; and (d) BSA Type IV: fetus with spinal and UC defects, abdominoschisis, anal atresia and/or other internal organs structural defects, and nonstructural limb defects. Two types of LBWC were differentiated: LBWC Type I: characterized by thoracoabdominoschisis and structural limb defects, and LBWC Type II: characterized by abdominoschisis and structural limb defects, corresponding to BSA type I and type III. This is the first report on BSA and LBWC in the pig.
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Affiliation(s)
| | - Luis Avedillo
- Department of Anatomy and Embryology, Universidad Complutense de Madrid, Madrid, Spain
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Abstract
OBJECTIVE. The purpose of this article is to describe the imaging findings associated with complex fetal abdominal wall defects and provide an algorithmic method for arriving at a final diagnosis. CONCLUSION. Fetal ventral abdominal wall defects are a complex group of conditions with a broad spectrum of associated multisystem anomalies and manifestations. Correct characterization and classification of these defects require not only familiarity with imaging findings but also a systematic approach to avoid diagnostic confusion.
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Martín-Alguacil N, Avedillo L. Body wall defects and amniotic band syndrome in pig (Sus scrofa domesticus). Anat Histol Embryol 2019; 49:144-149. [PMID: 31513296 DOI: 10.1111/ahe.12482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/16/2019] [Accepted: 08/04/2019] [Indexed: 02/06/2023]
Abstract
The amniotic band syndrome is a congenital condition. It is characterized by the presence of fibrous amniotic bands that may entangle or entrap different foetal parts in utero, resulting in deformation, malformation or disruption. We report on a female piglet presenting amniotic band adherences in the right abdominal flank, several body wall defects (gastroschisis, abdominoschisis with omphalocele), severe scoliosis, anomalous umbilical cord with single umbilical artery, anal atresia, anomalous liver and absent gall bladder, hypoplastic genitalia, ankylosis and arthrogryposis in pelvic limbs, and bilateral patellar agenesia. The ethiopatogenia is discussed, as well as the comparative and embryological implications.
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Affiliation(s)
- Nieves Martín-Alguacil
- Departmental Section of Anatomy and Embryology, School of Veterinary Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Avedillo
- Private practitioner, Clínica Veterinaria Salud Animal, Griñón, Madrid, Spain
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Bello O, Akinmoladun J. Prenatal sonographic diagnosis of limb body wall complex: A rare lethal fetal anomaly. SAHEL MEDICAL JOURNAL 2019. [DOI: 10.4103/smj.smj_51_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Coleman PW, Marine MB, Weida JN, Gray BW, Billmire DF, Brown BP. Fetal MRI in the Identification of a Fetal Ventral Wall Defect Spectrum. AJP Rep 2018; 8:e264-e276. [PMID: 30377551 PMCID: PMC6205859 DOI: 10.1055/s-0038-1675353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To ascertain if useful criteria for prenatal diagnosis of fetal ventral body wall defects (VBWDs) exists by reviewing published literature on diagnosis of VBWD as compared with our own diagnostic experience. Study Design A comprehensive literature review of diagnostic criteria of fetal VBWD including pentalogy of Cantrell (POC), omphalocele, exstrophy, imperforate anus, spina bifida (OEIS), cloacal exstrophy, limb-body wall complex (LBWC), and body stalk anomaly was performed followed by a retrospective review of all fetal magnetic resonance imaging (MRI) examinations from our medical center over a 2-year period. Results Classically, OEIS is omphalocele, bladder exstrophy, imperforate anus, and spina bifida. POC is defects of the supraumbilical abdomen, sternum, diaphragm, pericardium, and heart. LBWC is two of the following: exencephaly or enencephaly with facial clefts, thoracoschisis or abdominoschisis, and limb defects. Twenty-four cases of VBWD on MRI over a 24-month period were identified with seven cases involving defects of additional organ systems. Six of these seven cases demonstrated findings from two or more of the traditional diagnoses POC, OEIS, and LBWC making diagnosis and counseling difficult. Conclusion There is a lack of consensus on useful diagnostic criteria within the published literature which is reflected in our own diagnostic experience and poses a challenge for accurate prenatal counseling.
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Affiliation(s)
- Peter W Coleman
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Megan B Marine
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jennifer N Weida
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brian W Gray
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Deborah F Billmire
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brandon P Brown
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
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Bijok J, Massalska D, Kucińska-Chahwan A, Posiewka A, Ilnicka A, Jakiel G, Roszkowski T. Complex malformations involving the fetal body wall - definition and classification issues. Prenat Diagn 2018; 37:1033-1039. [PMID: 28809041 DOI: 10.1002/pd.5141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 08/01/2017] [Accepted: 08/06/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of the study is to analyse the sonographic features, cytogenetic results and pregnancy outcomes in complex malformations involving the body wall in a large cohort of fetuses with regard to different definitions proposed in the literature. METHOD A retrospective study on 96 fetuses with complex malformations comprising ventral wall, craniofacial structures, limbs and umbilical cord that were evaluated between 1997 and 2015. RESULTS The most common sonographic finding was an extensive ventral wall defect (95.8%; 92/96) comprising liver (94.6%; 87/92), intestine (82.6%; 76/92), heart (17.4%; 16/92) and bladder (8.7%; 8/92). Acrania and encephalocoele were observed in 24 and 9 fetuses (25.0%, 24/96; 9.4%, 9/96), respectively. Limb anomalies were present in 54 fetuses (56.3%; 54/96). Rudimentary or absent umbilical cord was observed in 62 fetuses (64.6%; 62/96). In 79 fetuses, there were additional multiple structural anomalies detected prenatally. None of the currently used definitions encompasses all possible phenotypes of body wall defects present in our cohort. Chromosomal aberrations were seen in 8 out of 60 cases with conclusive cytogenetic result (13.3%, 8/60). CONCLUSION Chromosomal anomalies are common, and karyotyping should be offered. There is a need for a more rigorous classification of complex malformations in order to better understand the underlying pathophysiology. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Julia Bijok
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Obstetrics and Gynecology, Witold Orlowski Public Teaching Hospital, Warsaw, Poland
| | - Diana Massalska
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Obstetrics and Gynecology, Witold Orlowski Public Teaching Hospital, Warsaw, Poland
| | - Anna Kucińska-Chahwan
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Obstetrics and Gynecology, Witold Orlowski Public Teaching Hospital, Warsaw, Poland
| | - Anna Posiewka
- Department of Obstetrics and Gynecology, Witold Orlowski Public Teaching Hospital, Warsaw, Poland
| | - Alicja Ilnicka
- Genetic Department of the Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Grzegorz Jakiel
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Obstetrics and Gynecology, Witold Orlowski Public Teaching Hospital, Warsaw, Poland
| | - Tomasz Roszkowski
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Obstetrics and Gynecology, Witold Orlowski Public Teaching Hospital, Warsaw, Poland
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Díaz C, Copado Y, Muñoz G, Muñoz H. MALFORMACIONES DE LA PARED ABDOMINAL. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bhat A, Ilyas M, Dev G. Prenatal sonographic diagnosis of limb-body wall complex: case series of a rare congenital anomaly. Radiol Case Rep 2016; 11:116-20. [PMID: 27257465 PMCID: PMC4878923 DOI: 10.1016/j.radcr.2016.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 02/07/2016] [Indexed: 12/01/2022] Open
Abstract
Three case reports of a rare congenital anomaly “limb-body wall complex” also known as “body stalk syndrome” are presented with prenatal ultrasonographic diagnostic features, immediate after delivery evaluation, and histopathologic analysis.
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Affiliation(s)
- Arshad Bhat
- Department of Radiodiagnosis and Imaging, SMGS Hospital, Govt. Medical College and Associated Hospitals, Jammu, 180001, India
| | - Mohd Ilyas
- Department of Radiodiagnosis and Imaging, Govt. Medical College and Associated Hospitals, Jammu, Lane 22, House No. 38, Tawi Vihar, Sidhra, Jammu, 180001, India
| | - Ghanshyam Dev
- Department of Radiodiagnosis and Imaging, Govt. Medical College and Associated Hospitals, Jammu, Lane 22, House No. 38, Tawi Vihar, Sidhra, Jammu, 180001, India
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Aguirre-Pascual E, Epelman M, Johnson AM, Chauvin NA, Coleman BG, Victoria T. Prenatal MRI evaluation of limb-body wall complex. Pediatr Radiol 2014; 44:1412-20. [PMID: 24928524 DOI: 10.1007/s00247-014-3026-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/01/2014] [Accepted: 05/01/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The sonographic (US) features of limb-body wall complex have been well documented; however the literature regarding the findings on MRI in limb-body wall complex is scant. OBJECTIVE To characterize the prenatal MRI features of limb-body wall complex. MATERIALS AND METHODS We performed a retrospective review of all MRI scans of fetuses diagnosed with limb-body wall complex at our institution from 2001 to 2011. Fetuses without correlating US scans or follow-up information were excluded. Three pediatric radiologists blinded to the specific US findings reviewed the prenatal MRIs. Images were evaluated for the organ location and attachment, the body part affected, characterization of the body wall defect, and spinal, limb and umbilical cord abnormalities. RESULTS Ten subjects met inclusion criteria. MRI was able to detect and characterize the body part affected and associated abnormalities. All fetuses had ventral wall defects, a small thorax and herniated liver and bowel. The kidneys were extracorporeal in three cases. The extruded organs were attached to the placenta or the uterine wall in all cases. Abnormal spinal curvatures of various degrees of severity were present in all cases. Eight cases had a short, uncoiled cord. Limb anomalies were present in 6 of the 10 cases. CONCLUSION We illustrate the common fetal MRI findings of limb-body wall complex. The prenatal diagnosis of limb-body wall complex and the differentiation of this defect from treatable abdominal wall defects are crucial to providing appropriate guidance for patient counseling and management.
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Affiliation(s)
- Elisa Aguirre-Pascual
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Abstract
We present autopsy findings of a case of limb body wall complex (LBWC). The fetus had encephalocele, genitourinary agenesis, skeletal anomalies and body wall defects. The rare finding in our case is the occurrence of both cranial and urogenital anomalies. The presence of complex anomalies in this fetus, supports embryonal dysplasia theory of pathogenesis for LBWC.
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Affiliation(s)
- Panduranga Chikkannaiah
- Department of Pathology, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
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Mathai AM, Menezes RG, Kumar S, Pai MR, Bhandary A, Fitzhugh VA. A fetal autopsy case of body stalk anomaly. Leg Med (Tokyo) 2009; 11:241-4. [PMID: 19643652 DOI: 10.1016/j.legalmed.2009.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 06/26/2009] [Accepted: 06/26/2009] [Indexed: 11/27/2022]
Abstract
Body stalk anomaly (BSA) is a sporadic polymalformative syndrome incompatible with extrauterine life. In utero detection of BSA by two-dimensional and three-dimensional ultrasonography and magnetic resonance imaging has been well documented. We herein describe a case of body stalk anomaly diagnosed at autopsy. The fetus had a large anterior midline abdominal wall defect with eventration of the visceral organs into the amnio-peritoneal sac and a completely absent umbilical cord. The associated anomalies included club foot, absent diaphragm, genitourinary, and gastrointestinal defects. The observed congenital anomalies supported the theory of embryonic dysgenesis as the etiologic factor. One of the major objectives in the performance of fetal autopsy is to be able to detect abnormalities that can have implications in future pregnancies. Despite the negligible familial recurrence rate of the broad spectrum of anomalies associated with this abdominal wall defect, the present case of fetal autopsy indeed delights to serve the living.
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Affiliation(s)
- Alka Mary Mathai
- Department of Pathology, Kasturba Medical College, Mangalore, India
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