Vertebral, anal, cardiac, tracheo-esophageal, renal, and limb(VACTERL) association is defined as the presence of at least three of the above-mentioned six manifestations. An estimated incidence of the VACTERL association is 1 in 20,000 to 35,000 live births although the diagnostic criteria vary. The VACTERL association is highly heterogeneous in clinical presentation. It may represent a spectrum from the less severely affected to the more severely affected. Diagnosis is difficult because of the number of disorders that have overlapping features with trisomy 13 syndrome, trisomy 18 syndrome, trisomy 21 syndrome, Feingold syndrome, and so on. The incidence of trisomy 18 syndrome, a type of a chromosomal disorder, is estimated to be 1 in 6,000-8,000 live births. It includes characteristic craniofacial anomalies, clenched hand with overlapping of index finger over third, fifth finger over fourth, underdeveloped thumbs, short sternum, cardiac anomalies such as ventricular septal defect, and renal anomalies such as horseshoe kidney. Approximately over 50% of infants with trisomy 18 syndrome live less than one week. In 1983, Khoury et al. reported VACTERL association combined with trisomy 18 syndrome. Here, we report a case of a low birth weight female infant with VACTERL association, whose second diagnosis is Edward syndrome, and that she also has another combined anomaly, meningomyelocele. To the best of our knowledge, this is the first reported case of VACTERL association with meningomyelocele combined with trisomy 18 syndrome in Korea.
VACTERL association은 척추기형, 직장항문기형, 심장기형, 기관식도기형, 콩팥기형, 사지기형의 여섯 가지 선천기형중 최소 세 가지 이상이 나타나는 경우에 진단할 수 있다. 생존 출생아 20,000-35,000명 중 1명의 비율로 매우 드물게발생하는 질환이며 임상양상이 매우 다양하고 trisomy 13 증후군, trisomy 18 증후군, trisomy 21 증후군, Feingold 증후군 등과 임상 양상이 중복되기 때문에 진단이 어렵다. trisomy 18 증후군(에드워드 증후군)은 특징적인 안면 모습, 특징적인 손발의 이상, 심실중격결손과 같은 심장기형, 마제신과 같은 콩팥 기형을 동반하며 50% 이상이 1주일 이내에 사망한다. 1983년에 VACTERL association 이 trisomy 18 증후군에 동반된 증례보고가 있었으나, 이후에는 보고된 바가없다. 저자들은 고령산모에서 부당경량아로 태어난 여아에서 VACTERL association과 척수수막류를 동반하며, trisomy 18 증후군을 진단한 증례를 경험하였기에 이를 보고하는 바이다.