Challenging the embryogenesis of cloacal exstrophy

As presently understood, cloacal exstrophy results from a migration failure of the lateral mesodermal folds of the infraumbilical anterior abdominal wall, and rupture of the resulting enlarged, persistent cloacal membrane before the eighth week of gestation. The authors present ultrasonographic evid...

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Bibliographic Details
Published in:Journal of pediatric surgery 1996-06, Vol.31 (6), p.768-770
Main Authors: Bruch, Steven W., Adzick, N.Scott, Goldstein, Ruth B., Harrison, Michael R.
Format: Article
Language:English
Subjects:
Abnormalities, Multiple
Adult
Biological and medical sciences
Cloaca - abnormalities
Cloaca - embryology
Diseases in Twins
Fatal Outcome
Female
Fetal Diseases - diagnostic imaging
Fetal Diseases - embryology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Infant, Newborn
Malformations
Medical sciences
Pregnancy
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Twins, Dizygotic
Ultrasonography, Prenatal
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Summary:As presently understood, cloacal exstrophy results from a migration failure of the lateral mesodermal folds of the infraumbilical anterior abdominal wall, and rupture of the resulting enlarged, persistent cloacal membrane before the eighth week of gestation. The authors present ultrasonographic evidence that disputes this embryological theory. Routine ultrasonography of a twin gestation at 18 weeks showed that one twin had a dilated cloacal abnormality, bilateral hydronephrosis, and oligohydramnios. Repeat ultrasonography at 24 weeks demonstrated rupture of the cloacal anomaly, with resolution of both the hydronephrosis and oligohydramnios. This twin was born with classic cloacal exstrophy. This striking ultrasound evidence of an intact cloacal membrane at 18 weeks, which ruptured before 24 weeks, relieving the urinary tract outlet obstruction, forces us to rethink how this surgically correctable anomaly develops.
ISSN:0022-3468
1531-5037
DOI:10.1016/S0022-3468(96)90128-1