Diagnostic and management challenges of prune belly syndrome in a low-income country: a neonatal case report

Prune Belly Syndrome (PBS) is a rare congenital anomaly defined by deficient abdominal wall musculature, urinary tract abnormalities, and cryptorchidism. It is associated with high morbidity, particularly in low-resource settings where prenatal imaging and specialized surgical care are limited. We report the first documented case of PBS from Somalia in a 6-day-old male neonate delivered without antenatal care. He presented with abdominal distension, respiratory distress, bilateral undescended testes, and oliguria. Laboratory tests showed impaired renal function and elevated inflammatory markers. Ultrasound revealed multilocular cystic hydronephrosis with thinned renal parenchyma, and a nephrostogram confirmed bilateral ureteropelvic junction obstruction. The infant was managed with oxygen, antibiotics, and bilateral percutaneous nephrostomy, which led to improved urine output, normalized renal function, and resolution of abdominal distension. He was discharged in stable condition after 15 days. This case underscores the variability of urinary tract pathology in PBS and highlights the importance of early recognition and timely surgical intervention to preserve renal function in resource-limited regions.