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Anatomy
Published in Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury, OSCEs for the MRCS Part B, 2017
Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury
Aberrations of this normal developmental process may lead to pathology: Failure of the urachus (that normally connects the bladder to the umbilicus) to obliterate may lead to a urachal fistula, sinus, diverticulum or cyst, often with leakage of urine from the umbilicus.Failure of the ductus arteriosus to obliterate at birth leads to a patent ductus arteriosus, resulting in non-cyanotic congenital heart disease.In 2% of cases, the vitello-intestinal duct persists as a Meckel's diverticulum with its associated complications.In some 20% of cases, the foramen ovale fails to obliterate completely at birth resulting in a patent foramen ovale. This may become the site for paradoxical embolism (where venous thrombus migrates and enters the systemic circulation through a patent foramen ovale), resulting in stroke.
The abdominal wall, hernias and the umbilicus
Published in Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse, Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse
An umbilical discharge is nearly always caused by infection in the umbilicus; nevertheless, remember the possibility of a urachal fistula, particularly if there are symptoms of urinary obstruction or a palpable bladder.
Pelvic Anatomy Through the Laparoscope
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
The obliterAted umbilicAl Arteries Are remnAnts of the fetAl circulAtion. occAsionAlly, they will remAin pAtent even in Adults. They Are brAnches of the internAl iliAc Arteries. The obliterAted umbilicAl Arteries cAn be used As lAterAl mArkers for entry into the cAve of retzius; however, if they Are not AdequAtely diAthermied prior to cutting, they mAy retrAct And bleed extensively (Figure 97.11). There Are inconsistencies in textbooks About AlternAtive nAmes for the obliterAted umbilicAl Arteries. some refer to them As the mediAl umbilicAl ligAments [4] And others As the lAterAl umbilicAl ligAments [5]. The most logicAl nomenclAture would seem to be thAt lAterAl umbilicAl ligAments Are the condensAtion of peritoneum over the inferior epigAstric vessels, while the mediAl umbilicAl ligAments Are equivAlent to the obliterAted umbilicAl Arteries. The mediAn umbilicAl ligAment is Another remnAnt of A fetAl structure, the urAchus. It runs from the dome of the blAdder to the umbilicus. It cAn occAsionAlly remAin pAtent cAusing A urAchAl fistulA to the umbilicus. All the umbilicAl ligAments cAn bleed when surgicAlly divided. The retropubic spAce cAn be opened 2–4 cm Above the dome of the blAdder. sometimes, it is helpful to fill the blAdder with 200–300 mL sAline or methylene blue to enAble its mArgins to be seen. In the midline, Anterior to the blAdder At the level of the pelvic floor Are the urethrA And dorsAl vein of the clitoris thAt should be Avoided. The spAce is bound lAterAlly by the obturAtor cAnAl And the Arcus tendineus fAsciAe pelvis (white line) (Figure 97.12). The obturAtor Artery is A brAnch of the internAl iliAc thAt runs on the lAterAl wAll of the pelvis to the obturAtor cAnAl. In About 25% of the populAtion, An AberrAnt obturAtor Artery Arises from the inferior epigAstric or externAl iliAc Artery. In some cAses, both A normAl And An AberrAnt obturAtor Artery Are present; the AberrAnt Artery is then cAlled An Accessory obturAtor Artery (Figure 97.5). The superior boundAry is the symphysis pubis And the pectineAl ligAment (Cooper's ligAment) (Figure 97.13). The obturAtor nerve (Figure 97.12) Arises from the lumbAr plexus (L2–L4). It enters the true pelvis through the greAter sciAtic forAmen And then runs in the extrAperitoneAl fAt Along the lAterAl wAll to reAch the obturAtor cAnAl. It then divides
The Allantois and Urachus: Histological Study Using Human Embryo and Fetuses
Published in Fetal and Pediatric Pathology, 2022
Xuelai Liu, Xianghui Xie, Zhe-Wu Jin, Huan Wang, Yanbiao Song, Peng Zhao, Long Li
Urachus abnormalities, such as urachal sinus, urachal cyst, and patent urachus (urachal fistula), are caused by the remnant of the urachus [6–8]. Because the lumen of the urachal remnants is continuous with the cavity of the urinary bladder, urachal sinuses can give rise to umbilical intermittent drainage, with patent urachus being associated with drainage of urine from the umbilicus. During development, the embryo is attached to the chorion by a connecting stalk composed of extraembryonic mesoderm within which the allantois grows. The allantois remains rudimentary as a transitory extraembryonic portion of the urachus [9]. Enlargement of the urinary bladder is thought to be accompanied by the conversion of the allantois to the urachus, with the allantois becoming progressively obliterated before week 12 of gestation [10].
Pfeiffer Syndrome Type 3 and Prune Belly Anomaly in a Female: Case Report and Review
Published in Fetal and Pediatric Pathology, 2019
Christian Peña-Padilla, Lorena Viramontes-Aguilar, Gerónimo Tavares-Macías, Lucina Bobadilla-Morales, Michael L. Cunningham, Sarah Park, Eugenio Zapata-Aldana, Jorge Román Corona-Rivera
Pfeiffer syndrome (PS) is an autosomal dominant (AD) entity (OMIM: #101600) characterized by craniosynostosis, broad thumbs, and great toes deviated to the preaxial side [1], and these clinical characteristics were delineated for the first time by Pfeiffer in 1964 [2]. PS is produced by a heterozygous pathogenic variant in the FGFR1 or FGFR2 genes. The classification of PS relies on the characteristic clinical manifestation of each type (described in Table 1), for example, type 1 has the mildest presentation of the three PS types, with a typical familial presentation, mid-face hypoplasia, broad thumbs and halluces, and syndactyly; type 2 presents with cloverleaf skull and severe ocular proptosis; and type 3 manifests a severe lethal craniosynostosis with severe ocular proptosis [3]. Other less frequent manifestations that overlap between the three types are visceral anomalies, elbow ankylosis, and early death, although these are more characteristic for PS types 2 and 3 [3]. The association of “prune belly” and PS was first reported by Bracero in a male infant with cloverleaf skull, ocular proptosis, broad thumbs, urachal fistula, and hypospadias [4]; PS type 2 in Cohen classification. Since then only one other case has been reported, a female infant with severe craniosynostosis, ocular proptosis and intestinal malrotation [5]; PS type 3 in Cohen classification. In none of these cases a molecular study was performed. Here we present the second case of PS type 3 and “prune belly,” with a literature review.