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Bladder Exstrophy

Dr Chor Ath Bladder exstrophy Bladder exstrophy is a congenital abdominal wall defect that occurs two to three times more commonly in males than females. Widening of the pubic symphysis, or the manta ray sign, is found with bladder exstrophy. Elevated alpha fetoprotein on the maternal quad screen may be the first indication of bladder exstrophy. Nonvisualization of the bladder on ultrasound is an additional sign of bladder exstrophy; however, the diagnosis can be difficult to diagnose sonographically. As low as 25% of patients with bladder exstrophy have a diagnosis made antenatally. Bladder exstrophy can be associated with cryptorchidism, inguinal hernias, and epispadias. OEIS complex, which was not present in this case, includes the congenital anomalies omphalocele, bladder/cloacal exstrophy, imperforate anus, and spinal anomalies. Cloacal exstrophy is a more extensive abdominal wall defect that includes bladder exstrophy, omphalocele, and an abdominal wall defect. Additional congenital abnormalities that result in widening of the pubic symphysis include prune belly syndrome, cleidocranial dysostosis, and osteogenesis imperfecta. Open book pelvic fractures also can result in the widening of the pubic symphysis. References Arlen AM, Smith EA. Disorders of the bladder and cloacal anomaly. Clin Perinatol. 2014;41(3):695-707. Ben-Chaim J, Docimo SG, Jeffs RD, Gearhart JP. Bladder exstrophy from childhood into adult life. J R Soc Med. 1996;89(1):39-46 Daltro P, Fricke BL, Kline-Faith BM, et al. Prenatal MRI of congenital abdominal and chest wall defects. AJR Am J Roentgenol. 2005;184(3):1010-1016. Meglin AJ, Balotin RJ, Jelinek JS, Fishman EK, Jeffs RD, Ghaed V. Cloacal exstrophy: Radiologic findings in 13 patients. AJR Am J Roentgenol. 1990;155(6):1267-1272.