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Kamoun D, Ben Hamed A, Abdenadher A, Kolsi N, Bouraoui A, Henteti N. The challenging diagnosis and management of the prune belly syndrome: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241258850. [PMID: 38812837 PMCID: PMC11135099 DOI: 10.1177/2050313x241258850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/15/2024] [Indexed: 05/31/2024] Open
Abstract
Prune belly syndrome is a rare disorder that occurs mainly in men. It is characterized by the triad of deficient abdominal wall muscles, the dilated urinary collecting system, bilateral cryptorchidism, and infertility. It mainly affects the genitourinary system, which involves the prognosis. We present the case of a preterm neonate male whose diagnosis of a prune belly was suspected in antenatal ultrasound. He had a urinary tract abnormality starting at 22 weeks of gestation. At birth, a clinical examination revealed a distended abdomen within a wrinkled and flaccid abdominal wall, a macropenis, and bilateral cryptorchidism. A urinary tract ultrasound revealed a right pyelocaliciel dilatation and a right megaureter with a megacystis. The neonate ultimately died due to severe renal failures. Prune Belly syndrome is a complex disease with a high mortality rate. Early antenatal ultrasound may ameliorate the prognosis.
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Affiliation(s)
- Dhouha Kamoun
- Department of Neonatology, CHU Hopital Hedi Chaker, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Amel Ben Hamed
- Department of Neonatology, CHU Hopital Hedi Chaker, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Amina Abdenadher
- Department of Neonatology, CHU Hopital Hedi Chaker, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Nadia Kolsi
- Department of Neonatology, CHU Hopital Hedi Chaker, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Amira Bouraoui
- Department of Neonatology, CHU Hopital Hedi Chaker, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Nedia Henteti
- Department of Neonatology, CHU Hopital Hedi Chaker, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
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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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Ngwanou DH, Ngantchet E, Moyo GPK. Prune-Belly syndrome, a rare case presentation in neonatology: about one case in Yaounde, Cameroon. Pan Afr Med J 2020; 36:102. [PMID: 32821313 PMCID: PMC7406465 DOI: 10.11604/pamj.2020.36.102.24062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022] Open
Abstract
The Prune-Belly syndrome (PBS) is a rare pathology predominating in male infants, classically manifesting with the triad including aplasia of the abdominal wall muscles, dilatation of the urinary tract, and testicular abnormalities. We report and discuss the case of a full-term male newborn, in whom clinical examination at birth revealed abdominal wall muscle hypoplasia, cryptorchidism, urinary tract dilatation and renal failure. The diagnosis was made based on physical assessment, abdominal ultra-sonographic imaging, and blood sampling of urea and creatinine. For such cases, the recommended surgical management usually consists in a sequential surgical intervention including urinary tract reconstruction, abdominoplasty, and orchidopexy. However, these could not be practiced in due time in our patient, who died on the seventh day of life because of kidney failure. The prognosis of infants with Prune-Belly syndrome may be improved by quality antenatal follow-up, to enable the early diagnosis and preparation for prompt surgical intervention.
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Affiliation(s)
- Dany Hermann Ngwanou
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Emmanuel Ngantchet
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
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Xu W, Wu H, Wang DX, Mu ZH. A case of prune belly syndrome. Pediatr Neonatol 2015; 56:193-6. [PMID: 23639747 DOI: 10.1016/j.pedneo.2013.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 10/17/2012] [Accepted: 03/28/2013] [Indexed: 11/26/2022] Open
Abstract
Prune belly syndrome (PBS) is a rare congenital disorder characterized by deficient abdominal wall muscles, urinary tract malformation, and, in males, cryptorchidism. We present a case of PBS in China. The patient was a newborn baby boy who had wrinkled, "prune-like" abdominal skin, bilateral cryptorchidism, and urinary system malformation, complicated with hypoplasia of the lung and branch of the coronary artery-right ventricular fistula. His kidney function was inadequate. The patient subsequently died at age 28 days due to septicemia from a severe urinary tract infection.
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Affiliation(s)
- Wei Xu
- Department of Neonatology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China.
| | - Dong-Xuan Wang
- Department of Ultrasonic Diagnosis, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
| | - Zhi-Hong Mu
- Department of Neonatology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
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Affiliation(s)
- R Jha
- Department of Nephrology, Medwin Hospital, Nampally, Hyderabad, Andhra Pradesh, India
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Basso MD, Favretto CO, Cunha RF. The association between prune belly syndrome and dental anomalies: a case report. BMC Oral Health 2012; 12:56. [PMID: 23249412 PMCID: PMC3564721 DOI: 10.1186/1472-6831-12-56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/17/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prune belly syndrome is a rare condition produced by an early mesodermal defect that causes abdominal abnormalities. However, the literature indicates that disturbances related to ectodermal development may also be present. This is the first case report in the literature to suggest that dental abnormalities are part of the broad spectrum of clinical features of prune belly syndrome. Because the syndrome causes many serious medical problems, early diagnosis of abnormalities involving the primary and permanent dentitions are encouraged. CASE PRESENTATION The authors report the clinical case of a 4-year-old Caucasian boy with prune belly syndrome. In addition to the triad of abdominal muscle deficiency, abnormalities of the gastrointestinal and urinary tracts, and cryptorchidism, a geminated mandibular right central incisor, agenesis of a mandibular permanent left incisor, and congenitally missing primary teeth (namely, the mandibular right and left lateral incisors) were noted. CONCLUSION This original case report about prune belly syndrome highlights the possibility that dental abnormalities are a part of the broad spectrum of clinical features of the syndrome. Therefore, an accurate intra-oral clinical examination and radiographic evaluation are required for patients with this syndrome in order to provide an early diagnosis of abnormalities involving the primary and permanent dentitions.
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Affiliation(s)
- Maria Daniela Basso
- Disciplina de Odontopediatria e Clínica Integrada Infantil, UNIOESTE – Univ. Estadual do Oeste do Paraná, Jardim Universitário, Rua Universitária 2069, Cascavel, PR (85819-110), Brazil
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Zugor V, Schott GE, Labanaris AP. The Prune Belly syndrome: urological aspects and long-term outcomes of a rare disease. Pediatr Rep 2012; 4:e20. [PMID: 22802998 PMCID: PMC3395978 DOI: 10.4081/pr.2012.e20] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 11/17/2011] [Accepted: 11/18/2011] [Indexed: 11/23/2022] Open
Abstract
Prune-Belly syndrome is a disorder characterized by the following triad of symptoms: deficiency of the abdominal muscles, malformations of the urinary tract and bilateral cryptorchidism. This study included a total of 16 patients. The findings included clinical characteristics, diagnostics, therapy and long-term clinical outcomes. All patients were asked to complete a questionnaire and, in some cases, were given further examination. All patients were diagnosed with congenital aplasia of the abdominal wall and a variety of urogenital malformations. Cryptorchidism was present in 11 patients (68.8%), malformations of the prostate in 3 (18.8%), urethral malformations in 8 (50%) and mega-ureter in 14 patients (87.5%). A mega-bladder was observed in 13 patients (81.3%). Distinctive renal malformations, such as renal dysplasia, in 3 patients (18.8%) and hydronephrosis in 9 patients (56.3%), respectively. Abdominoplasty was performed on 4 patients (25%). Urethral surgery was performed in 10 patients (62.5%). Seven patients (43.8%) required ureter surgery, most of which involved re-implantation of the ureter and, in some cases, additional ureter modeling. Renal surgery was performed on 5 patients. Four patients with non-functioning kidneys with hydronephrosis underwent a nephrectomy and one patient pyeloplasty. We demonstrate that successful treatment is possible even in cases of serious and complex malformations, such as those of the Prune-Belly syndrome. Treatment must be tailored to the individual patient. The severity of the renal dysplasia is the main prognostic factor.
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Affiliation(s)
- Vahudin Zugor
- Department of Urology and Pediatric Urology-Prostate Center Northwest, St. Antonius Medical Center, Gronau
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Richer J, Milewicz DM, Gow R, de Nanassy J, Maharajh G, Miller E, Oppenheimer L, Weiler G, O'Connor M. R179H mutation in ACTA2 expanding the phenotype to include prune-belly sequence and skin manifestations. Am J Med Genet A 2012; 158A:664-8. [PMID: 22302747 DOI: 10.1002/ajmg.a.35206] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 11/30/2011] [Indexed: 12/16/2022]
Abstract
Mutations in ACTA2 (smooth muscle cell-specific isoform of α-actin) lead to a predisposition to thoracic aortic aneurysms and other vascular diseases. More recently, the ACTA2 R179H mutation has been described in individuals with global smooth muscle dysfunction. We report a patient heterozygous for the mutation in ACTA2 R179H who presented with megacystis at 13 weeks gestational age and, at birth, with prune-belly sequence. He also had deep skin dimples and creases on his palms and soles, a finding not previously described but possibly related to ACTA2. To our knowledge, this is the first report of the R179H mutation in ACTA2 in a child with prune-belly sequence. We think the R179H mutation in ACTA2 should be included in the differential diagnosis of individuals presenting with the sequence without an identified mechanical obstruction. Furthermore, as ACTA2 R179H has been reported in patients with severe vasculomyopathy and premature death, we recommend that molecular testing for this mutation be considered in fetuses presenting with fetal megacystis with a normal karyotype, particularly if the bladder diameter is 15 mm or more, to allow expectant parents to make an informed decision.
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Affiliation(s)
- J Richer
- Genetic Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
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The absence of the verumontanum at voiding cystourethrography as a sign of prostate maldevelopment. Adv Urol 2010; 2011:982709. [PMID: 21151546 PMCID: PMC2997494 DOI: 10.1155/2011/982709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/01/2010] [Indexed: 11/17/2022] Open
Abstract
Prostate maldevelopment in prune-belly syndrome has only been described at necropsy. No reports are available in the “in vivo” studies. The absence of the verumontanum at voiding cystourethrography correlates with verumontanum and prostate hypoplasia. This radiographic sign can represent the earliest finding in prostate maldevelopment and might contribute to the “in vivo” assessment of the disease, especially in doubtful cases.
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Chen L, Cai A, Wang X, Wang B, Li J. Two- and three-dimensional prenatal sonographic diagnosis of prune-belly syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:279-282. [PMID: 20014136 DOI: 10.1002/jcu.20653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report the prenatal diagnosis of 6 cases of Prune-belly syndrome in the 2(nd) trimester. The sonographic diagnosis was based on the findings of oligohydramnios, renal anomalies, and a lower abdominal cystic mass representing the abnormal dilatation of the bladder on conventional 2-dimensional sonographic examination. We discuss the role of Doppler imaging and 3-dimensional sonography as complementary methods to conventional sonography. Four of our 6 cases were confirmed with associated defects.
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Affiliation(s)
- Lizhu Chen
- Department of Ultrasound, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, Liaoning, China
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Chiu HS, Szucsik JC, Georgas KM, Jones JL, Rumballe BA, Tang D, Grimmond SM, Lewis AG, Aronow BJ, Lessard JL, Little MH. Comparative gene expression analysis of genital tubercle development reveals a putative appendicular Wnt7 network for the epidermal differentiation. Dev Biol 2010; 344:1071-87. [PMID: 20510229 DOI: 10.1016/j.ydbio.2010.05.495] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 04/23/2010] [Accepted: 05/15/2010] [Indexed: 02/08/2023]
Abstract
Here we describe the first detailed catalog of gene expression in the developing lower urinary tract (LUT), including epithelial and mesenchymal portions of the developing bladder, urogenital sinus, urethra, and genital tubercle (GT) at E13 and E14. Top compartment-specific genes implicated by the microarray data were validated using whole-mount in situ hybridization (ISH) over the entire LUT. To demonstrate the potential of this resource to implicate developmentally critical features, we focused on gene expression patterns and pathways in the sexually indeterminate, androgen-independent GT. GT expression patterns reinforced the proposed similarities between development of GT, limb, and craniofacial prominences. Comparison of spatial expression patterns predicted a network of Wnt7a-associated GT-enriched epithelial genes, including Gjb2, Dsc3, Krt5, and Sostdc1. Known from other contexts, these genes are associated with normal epidermal differentiation, with disruptions in Dsc3 and Gjb2 showing palmo-plantar keratoderma in the limb. We propose that this gene network contributes to normal foreskin, scrotum, and labial development. As several of these genes are known to be regulated by, or contain cis elements responsive to retinoic acid, estrogen, or androgen, this implicates this pathway in the later androgen-dependent development of the GT.
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Affiliation(s)
- Han Sheng Chiu
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia 4072, Australia
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DNA hypomethylation, transient neonatal diabetes, and prune belly sequence in one of two identical twins. Eur J Pediatr 2010; 169:207-13. [PMID: 19521719 DOI: 10.1007/s00431-009-1008-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 05/30/2009] [Indexed: 10/20/2022]
Abstract
One known genetic mechanism for transient neonatal diabetes is loss of methylation at 6q24. The etiology of prune belly sequence is unknown but a genetic defect, affecting the mesoderm from which the triad abdominal muscle hypoplasia, urinary tract abnormalities, and cryptorchidism develop, has been suggested. We investigated a family, including one twin, with transient neonatal diabetes and prune belly sequence. Autoantibody tests excluded type 1 diabetes. Microsatellite marker analysis confirmed the twins being monozygotic. We identified no mutations in ZFP57, KCNJ11, ABCC8, GCK, HNF1A, HNF1B, HNF3B, IPF1, PAX4, or ZIC3. The proband had loss of methylation at the 6q24 locus TNDM and also at the loci IGF2R, DIRAS3, and PEG1, while the other family members, including the healthy monozygotic twin, had normal findings. The loss of methylation on chromosome 6q24 and elsewhere may indicate a generalized maternal hypomethylation syndrome, which accounts for both transient neonatal diabetes and prune belly sequence.
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Diao B, Diallo Y, Fall P, Ngom G, Fall B, Ndoye A, Fall I, Ba M, Ndoye M, Diagne B. Syndrome de Prune Belly : aspects épidémiologiques, cliniques et thérapeutiques. Prog Urol 2008; 18:470-4. [DOI: 10.1016/j.purol.2008.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 03/29/2008] [Accepted: 04/08/2008] [Indexed: 11/28/2022]
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Renal tract malformations: perspectives for nephrologists. ACTA ACUST UNITED AC 2008; 4:312-25. [DOI: 10.1038/ncpneph0807] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 03/05/2008] [Indexed: 01/13/2023]
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