Anatomic and Functional Reconstruction of the Abdominal Wall in Prune Belly Syndrome: A Case Report

Prune belly syndrome (PBS), or Eagle-Barrett syndrome, is a rare congenital disorder marked by abdominal wall muscle deficiency, urinary tract anomalies, and cryptorchidism, causing significant abdominal wall laxity and functional impairment. This case report discusses an innovative approach to abdominal wall reconstruction in a 19-year-old male patient with PBS and associated conditions, including chronic renal failure and spina bifida. Previously, he underwent distal ureterectomy and vesicoureteral reimplantation at the age of two years to correct urinary tract dilation and bilateral orchiopexy. Preoperative examination revealed a distended abdomen, hypoplastic anterior abdominal wall musculature with associated abdominal flaccidity, and the presence of a malformed umbilical remanent. Due to the extensive abdominal muscle deficiency, the surgical team combined abdominoplasty with bilateral rectus femoris and sartorius muscle transfers. This dynamic reconstruction aimed to enhance abdominal wall function and aesthetics. Postoperative complications included skin flap necrosis, effectively managed with debridement, an abdominal anchor device, and skin grafting. Over a 41-month follow-up, the patient showed marked improvement in abdominal strength, posture, and ambulation, with no recurrence of abdominal bulging. This case highlights the potential of combining fascial plication and muscle transfer for sustained functional and aesthetic benefits in PBS, supporting its consideration in similar complex cases.