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Abnormal aorta and iliac arteries in children with urogenital abnormalities
E H Dykes1, I Oesch, P G Ransley
1Hospitals for Sick Children, London, England.
Insights
This study identifies a critical link between congenital urogenital abnormalities and unusual positioning of major pelvic arteries in children. Awareness is crucial for surgeons to prevent accidental vascular injury during reconstructive surgery.
Area of Science:
- Pediatric Surgery
- Urology
- Vascular Anatomy
Background:
- Retroiliac ureters are known associations with urogenital anomalies.
- The iliac artery typically maintains a retroperitoneal course.
Observation:
- Seven children with complex urogenital malformations (cloacal malformation, bladder agenesis, urogenital sinus, neuropathic bladder) presented with distorted lower aorta and iliac arteries.
- In these cases, the distal aorta and/or iliac arteries were located within the peritoneal cavity, anterior to the bladder.
- Specific anomalies included the aorta being tethered to the umbilicus and iliac arteries traversing the pelvis posterior to the pubic bones.
Findings:
- The aberrant vascular anatomy posed a significant operative hazard.
- One patient experienced inadvertent division and subsequent repair of an anomalous iliac artery during cloacal reconstruction.
- The study highlights a previously under-recognized association between major vascular anomalies and severe urogenital/cloacal malformations.
Implications:
- Surgeons must be aware of this association to avoid compromising lower limb arterial supply during reconstructive procedures.
- Preoperative identification of these vascular anomalies is vital for safe surgical planning.
- This finding has significant implications for the management of complex pediatric congenital anomalies.
Abstract:
Retroiliac ureters have been found in association with a variety of urogenital abnormalities but the iliac artery usually retains a retroperitoneal position. We report 7 children with various urogenital abnormalities (cloacal malformation 4, bladder agenesis 1, urogenital sinus 1, neuropathic bladder 1) in whom the lower aorta and iliac arteries were so distorted as to pose a significant operative hazard. In all cases the distal aorta and/or iliac arteries lay within the peritoneal cavity, often anterior to the bladder. In 3 cases the aorta was fixed by a short ligament to the umbilicus, and in 3 patients one of the iliac arteries ran across the pelvis behind the pubic bones before entering the leg. In one patient an anomalous iliac artery was inadvertently divided during reconstruction of a cloaca; when recognized, the vessel was rejoined. Recognition of an association between urogenital or cloacal malformations and a major vascular anomaly is of great importance to reconstructive surgeons who, if not forewarned, could unintentionally compromise the arterial supply to one or both lower limbs.