Medical College and K. M Hospital, Mumbai, India. Abstract A rare case of ectopia vesicae and intrauterine pregnancy in a 25 years old, unmarried woman is presented. A medical termination of pregnancy was performed by dilatation and evacuation.
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This is a congenital abnormality in which there is incomplete development or absence of the infra-umbilical part of the anterior abdominal wall, associated with incomplete development of the anterior wall of the bladder. Ectopia vesicae are rare and its incidence is one in 50, births.
Two types are commonly seen. Complete ectopia vesicae Incomplete ectopia vesicae The complete variety is more common. In incomplete variety the pubic bones are united and the external genitalia are almost normal.
The ratio is Due to pressure of the viscera behind it, the posterior wall of the bladder protrudes through the defect. This is deep red in color. Frequently the averted mucous membrane becomes ulcerated and painful.
It may undergo cancerous changes and form adeno-carcinoma. It bleeds readily. When this mucous membrane is upwards, paler, wet trigone becomes visible. Effluxes of urine can be seen from the ureteric orifices. A line of demarcation becomes obvious between the protruding mucous membrane and the adjacent skin. When the exposed bladder wall is pushed behind with the finger the firm edge beneath the junction can be felt as the defect in the abdominal wall.
There are certain associated abnormalities- like umbilicus is absent, umbilical hernia, rectal sphincter etc. In females clitoris is cleft, pubic bones are separated and there are recurrent attacks of infection. Complications Of Exstrophy Of Bladder The exposed bladder mucous membrane is usually ulcerated and becomes painful. Continuous bad odor of urine accompanies the patient. Cancerous change may take place at the exposed mucous membrane of the urinary bladder and it may be the ultimate site of an adeno-carcinoma.
Half of the people die of renal failure. First of all diversion of urine has to be performed. Later, after some months the urinary bladder is excised and closure is done. The operation is performed between 4 to 6 years of age. Diversion of urine into an ileac conduit with excision of the bladder can be performed at 5 years of age. As problem of infection is less, renal function is better and this is a better operation.
Recently attempts are being made to reconstruct the bladder and sphincters within the first year of life. With these treatments for Ectopia Vesicae, corrective measures can be taken to control and improvise the condition of ailing patients.
This can include other abnormally developed organs. Instead of closing up, the chest remains open. This happens very early on in embryonic development. Some theories include: intrauterine drug exposure rupture of fetal membranes chorion or yolk sac Damage to the amniotic sac amniotic band syndrome may also be a cause. A rupture of the sac in early development can cause fibrous bands of amnion, the inner membrane of an embryo, to get tangled up with the embryo. This can impair development or cause deformities of the affected parts, including the heart. A male fetus is more likely to develop ectopia cordis.
What is the cost? Answer: Ectopia Vesicae is a congenital anomaly which is characterized by eversion of the urinary bladder. The condition my involve absence of a portion of the lower abdominal wall, exposing the bladder or absence of anterior wall of the bladder. The condition may also present in the form of eversion of the posterior wall through a deficit. Ectopia Vesicae Treatment and Management The management of the condition is fairly complex and intricate. It is desirable that you repair the bladder immediately after delivery, as, otherwise it may be associated with social stigma. The only management of the condition is surgical, which involves suturing of the muscle and fascial layer to protect the anterior portion of the bladder.