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2010-10-04-12 Answer to the case of the week #280 © Bronshtein
Answer to the case of the week #280

November 4, 2010 - November 18, 2010

Moshe Bronshtein, MD.

Department Obstetrics Gynecology, Rambam Medical Center, Haifa, 31096 Israel.

Case report

This is a case of a 30-year-old G1 P0 with hypothyroidism and severe hyperemesis gravidarum. The transvaginal ultrasound examination at 15 weeks of gestation showed the following findings: absence of the urinary bladder, normal amount of the amniotic fluid and abnormal looking male genitalia. Doppler examination showed a jet of urination from the anterior abdominal wall, next to the penis. Our diagnosis based on the ultrasound examination was a bladder exstrophy with epispadia.

Patient decided for the pregnancy termination just 2 days after our examination. The pathologist confirmed our diagnosis.

Images 1,2: Transverse section of the lower abdomen, Doppler imaging shows umbilical arteries, note the absence of the urinary bladder in between. Arrow indicates a flow which was detected lateral to the umbilical artery with an external jet coming out of the abdominal wall, next to the male genitalia.

Images 3:
Image of the fetus after pregnancy termination, note epispadia and bladder exstrophy. The probe is inserted in the opening of the urether which is located on the abdominal wall. The urine jet from this urether is demonstrated on the clip below.

Video 1:
Video demonstrating a jet of urine.

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