Management of an infant with prune belly syndrome under caudal anaesthesia undergoing laparoscopic surgery

Prune belly syndrome (PBS) is a rare congenital disorder predominantly affecting male infants and is characterised by deficient abdominal musculature, urinary tract anomalies and bilateral cryptorchidism. Its multisystem involvement presents significant anaesthetic challenges. We report the anaesthetic management of a male infant with PBS posted for laparoscopic first-stage orchidopexy. Examination revealed a flabby, wrinkled abdomen with bulging flanks, easily palpable enlarged hydronephrotic kidneys, a hypoplastic scrotum and absent testes. After obtaining written informed consent and ensuring appropriate fasting, caudal anaesthesia was administered in the lateral position under ketamine sedation. Surgery was performed laparoscopically in the supine position. Adequate surgical conditions were achieved without airway instrumentation or neuromuscular blockade, and the perioperative course was uneventful. This case highlights that in carefully selected infants undergoing short, uncomplicated laparoscopic procedures, high-volume dilute caudal anaesthesia with sedation can be a safe and effective alternative to general anaesthesia in PBS.