Antenatal Diagnosis

Austin and Homsy attempted to streamline the antenatal diagnosis of cloacal exstrophy by a retrospective analysis of antenatal scans of affected patients. Features present in more than 50% of cases (major criteria) include nonvisualization of the bladder, a large midline anterior abdominal wall defect or a cystic anterior wall structure, a large omphalocele, and myelomeningocele. Features present in less of 50% of cases (minor criteria) are ascites, lower extremity de-

Elephant Trunk Sign Fetal Ultrasound
Fig. 14.2 Cloacal exstrophy with arrow pointing to prolapsed ileum (elephant trunk deformity). Fetus also shows mesomelia and talipes

fects, renal anomalies, widened pubic arches, narrow thorax, hydrocephalus, and a single umbilical artery [12]. In 1999, Hamada et al. added the visualization of the elephant trunk-like protrusion of the proximal midgut as a minor criterion [13].

At the Fetal Care Research Foundation in Chennai India, 57,993 pregnancy ultrasound scans were performed between January 1998 and December 2004, and 5,825 anomalies were detected. Twenty-five fetuses were noted to have the body stalk anomaly, 7 had vesical exstrophy, and 5 were antenatally detected to have cloacal exstrophy. In a retrospective review of these latter five ultrasounds, the following were identified: omphalocele (4/5), nonvisualization of the bladder (4/5), lower-limb anomalies (4/5), infraum-bilical body wall defect (4/5), renal anomalies (3/5), meningomyelocele (2/5), narrow thorax (2/5), single umbilical artery (1/5), hydrocephalus (1/5), ascites (1/5), and widened pubic arch (1/5). Prolapse of the small bowel, giving the elephant-trunk deformity, was noted in one case (Fig. 14.2).

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