Complex Malformation (Differential Diagnosis)

6-day-old newborn with an externally recognizable and complex malformation of the pubic region. Above the suspected abnormal external genitals two masses covered with a reddish mucous membrane prolapse on each side. Between these masses a plate with a groove in the midline is visible which lies somewhat deeper. The diagnosis of this complex malformation is a vesicointestinal fissure which has several variants. The two lateral masses are lateral exstrophic bladders and the plate in the midline is an open part of intestine; the upper end of the latter structure runs into the small bowel like a fistula and the lower end into the colon. In spite of the frequently observed low situated omphalocele (which lies in our case above the described complex malformation) the described structures and their arrangement allow a clinical differentiation from a gastroschisis, omphalocele, or bladder exstrophy.