P19.10: Prenatal imaging findings in cloacal extrophy

Abstract

Background: congenital inguinal hernias are rarely detected in utero, with prenatal diagnoses often made in the 3rd trimester. While most reported cases are isolated, fetal inguinal hernia has also been reported with rib and vertebral anomalies in the setting of Jarcho-Levin syndrome. Case: we report a case and associated images and video of a male infant prenatally diagnosed with a large inguinal hernia and multiple other anomalies. Prenatal ultrasound at 32 weeks revealed a large homogeneous solid mass anterior to the fetal pelvis measuring 4.70 × 4.62 × 4.88 cm adjacent to a normalappearing phallus (image 1). Peristalsis was noted within the mass, with bowel loops extending from the fetal abdomen into the mass suggesting an inguinal hernia (video). A normal cord insertion was noted. Additional anomalies apparent by prenatal sonogram included lumbosacral myelomeningocele with Chiari malformation, d-transposition of the great arteries, multiple hemivertebrae, and lower extremities fixed in flexion with short longs bones and bilateral talipes. Prenatal MRI confirmed the above findings. Amniocentesis revealed a normal male karyotype with a negative microarray. Cesarean delivery of a 2630 g male was performed at term due to breech presentation. Postnatal examination confirmed prenatal findings with no clinical or molecular evidence of a genetic abnormality. Conclusion: Inguinal hernias may be detected prenatally by identification of peristalsing bowel loops extending from the fetal abdomen into an external pelvic mass. Close evaluation for associated anomalies is required, as other structural anomalies may be present even the absence of a syndromic diagnosis.