Rationale: Sirenomelia and anencephaly are well-defined congenital malformations that usually occur independently.
Patient concerns: We report a case of combined sirenomelia, anencephaly and complete rachischisis, diagnosed in the 16th week of gestation.
Diagnoses: To our knowledge, this is the 7th case in the literature and the first that is diagnosed so early in pregnancy.
Interventions: The final diagnosis is confirmed with radiological examination after the termination of pregnancy.
Outcomes: Prenatal diagnosis of sirenomelia is difficult due to the presence of kidney agenesis and severe oligohydramnios.
Lessons: The combination of sirenomelia and craniorachischisis totalis is extremely rare and prenatal ultrasound scan are a challenge, even for experts in the field.
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