Prune belly syndrome

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Prune belly syndrome
Classification and external resources
Prune belly syndrome.JPEG
Prune belly syndrome in an Egyptian child with Down syndrome.
ICD-10 Q79.4
ICD-9 756.71
OMIM 100100
DiseasesDB 31089
MedlinePlus 001269
eMedicine med/3055 radio/575
MeSH D011535

Prune belly syndrome, also referred to as abdominal muscle deficiency syndrome, congenital absence of the abdominal muscles, Eagle-Barrett syndrome,[1] Obrinsky syndrome,[2] Fröhlich syndrome,[3] or, rarely, triad syndrome, is a rare, genetic birth defect affecting about 1 in 40,000 births.[4] About 97% of those affected are male. Prune belly syndrome is a congenital disorder of the urinary system, characterized by a triad of symptoms. The syndrome is named for the mass of wrinkled skin that is often (but not always) present on the abdomens of those with the disorder.

Symptoms[edit]

  • A partial or complete lack of abdominal wall muscles. There may be wrinkly folds of skin covering the abdomen.
  • Cryptorchidism (undescended testicles) in males
  • Urinary tract abnormality such as unusually large ureters, distended bladder, accumulation and backflow of urine from the bladder to the ureters and the kidneys (vesicoureteral reflux)
  • Frequent urinary tract infections due to the inability to properly expel urine.
  • Later in life, a common symptom is post-ejaculatory discomfort. Most likely a bladder spasm, it lasts about two hours.
  • Ventricular septal defect
  • Malrotation of the gut
  • Club foot

Diagnosis[edit]

Prune belly syndrome can be diagnosed via ultrasound while a child is still in-utero.[5] An abnormally large abdominal cavity resembling that of an obese person is the key indicator, as the abdomen swells with the pressure of accumulated urine. In young children, frequent urinary tract infections often herald prune belly syndrome, as they are normally uncommon. If a problem is suspected, doctors can perform blood tests to check kidney function. Another test that may reveal the syndrome is the voiding cystourethrogram.

A genetic predisposition has been suggested, and PBS is much more common in males.

Complications[edit]

Prune belly syndrome can result in the distending and enlarging of internal organs such as the bladder and intestines. Surgery is often required but will not return the organs to a normal size. Bladder reductions have shown that the bladder will again stretch to its previous size due to lack of muscle. Also many complications can come from enlarged/malformed kidneys which warrant the child to go on dialysis or require a kidney transplant. With proper treatment long healthy lives are possible.

Musculoskeletal abnormalities include pectus excavatum, scoliosis, and congenital dislocations including the hip. Diagnosis of prune belly syndrome necessitates thorough orthopaedic evaluation because of the high prevalence of associated musculoskeletal abnormalities.[6]

Treatment[edit]

The type of treatment, like that of most disorders, depends on the severity of the symptoms. One option is to perform a vesicostomy, which allows the bladder to drain through a small hole in the abdomen, thus helping to prevent urinary tract infections. Similarly, consistent self catheterization, often several times per day, can be an effective approach to preventing infections. A more drastic procedure is a surgical "remodeling" of the abdominal wall and urinary tract. Boys may have an orchiopexy, which moves the testicles to their proper place in the scrotum.

Even with treatment, many patients experience renal failure.

References[edit]

  1. ^ Eagle JF, Barrett GS (1950). "Congenital deficiency of abdominal musculature with associated genitourinary abnormalities: A syndrome. Report of 9 cases". Pediatrics 6 (5): 721–36. PMID 14797335. 
  2. ^ Obrinsky W (1949). "Agenesis of abdominal muscles with associated malformation of the genitourinary tract; a clinical syndrome". Am J Dis Child 77 (3): 362–73. doi:10.1001/archpedi.1949.02030040372008. PMID 18116668. 
  3. ^ Frolich, F. Der Mangel der Muskeln, insbesondere der Seitenbauchmuskeln. Dissertation: Wurzburg 1839.
  4. ^ Baird PA, MacDonald EC (1981). "An epidemiologic study of congenital malformations of the anterior abdominal wall in more than half a million consecutive live births". Am. J. Hum. Genet. 33 (3): 470–8. PMC 1685049. PMID 6454342. 
  5. ^ synd/1499 at Who Named It?
  6. ^ Brinker MR, Palutsis RS, Sarwark JF 1995. The orthopaedic manifestations of prune-belly (Eagle-Barrett) syndrome. J Bone Joint Surg Am. 77(2):251-7

External links[edit]