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Amniotic bands, anorectal and bladder agenesis an unique association in a twin pregnancy with fetus papyraceus

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Poor cloacal development and an inadequate septation can generate a wide range of genitourinary and terminal portions of the digestive tract malformations. The bladder agenesis is an extremely rare congenital genitourinary anomaly.
Successful treatment and the long-term prognosis are usually poor because of the associated abnormalities. We want to report an uncommon case related to cloacal maldevelopment, a complex association of urogenital and hindgut abnormalities in a twin pregnancy with fetus papyraceus (mummified) and amniotic bands. It is about a twin pregnancy with one fetus stopped evolving at 12 weeks of gestation and another fetus that has continued to develop up to 23 weeks. The birth occurred at 23 weeks by small Caesarean section and we extracted a mummified fetus of 45 grams and a nonviable female fetus weighed 420 g with multiple malformations.
Urogenital anomalies consisted of absence of vagina and urethra, bladder agenesis with ectopic ureteric opening. In addition, this second girl fetus had anorectal agenesis, imperforate anus without fistula as a hindgut anomaly but with omphalocele and a blind sigmoidum at this level. Clinical, anatomopathological evaluation and embryological review are made to explain the concomitant occurrence of these rare malformations.

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