An exceptional case of bladder exstrophy with pubic symphysis diastasis in a 3-year-old male child

¹Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India, ²Department of Obstetrics and Gynecology, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

^&Corresponding author
Rahul Agola, Department of Obstetrics and Gynecology, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

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Bladder exstrophy is a rare birth defect in which the anterior wall of the abdomen over the bladder is not closed in the intrauterine period, hence the child born with exposed bladder. Incidence of bladder exstrophy is 1/10,000 childbirths. Complaints would vary from exposed bladder, incontinence or leakage of urine, defect in genitals and pelvic bones as well as defect in intestine and reproductive organs. Mostly patient get operated with bladder exstrophy repair in infant age. If it gets neglected, it needs stage-wise surgery in this case. Parents of a 3-year-old male child came to paediatric surgeon outpatient department (OPD) with congenital bladder exstrophy. Orthopaedic surgeons´ opinion was taken in view of pubic diastasis. In infant age, there is no need of additional concern of pubic diastasis. At the age of 3, acetabulo-pelvic surgeon is adviced for external fixator application of pelvic wings to decrease tension on reconstructed bladder wall and the inter-pubic ligament. The patient was managed for neglected bladder exstrophy. Reconstruction of the abdominal wall, the urethra as well as the application of an external fixator were done.

Figure 1: (A) patient came with birth defect (bladder exstrophy); (B) intra operative picture (abdominal wall reconstruction for bladder); (C) after abdominal wall reconstruction and external fixator application; (D) X-ray pelvis with both hips post operatively