[Simple gastroschisis complicated by multiple perforations, frozen abdomen, and loss of abdominal domain]
Diana Cayetano Cabrera1, Cristian Zalles Vidal2, Alejandro Peñarrieta Daher3
1Hospital Infantil de México Federico Gómez. Cirugía Pediátrica. Ciudad de México.. diana_acc@live.com.
Insights
Gastroschisis, a congenital defect, can cause short bowel syndrome. This case study details successful management of complex gastrointestinal complications in a newborn with gastroschisis, leading to full recovery.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Malformations
Background:
- Gastroschisis is a congenital abdominal wall defect leading to visceral herniation.
- It is a significant cause of short bowel syndrome in infants.
- Complications during management can exacerbate intestinal issues.
Observation:
- A full-term newborn with simple gastroschisis presented with an open abdomen, enteroatmospheric fistulas, and loss of domain.
- The patient experienced multiple gastrointestinal complications during initial treatment.
- Referral to a specialized center was necessary for advanced management.
Findings:
- A multimodal approach was employed over three months, including primary intestinal repair, jejunostomies with distal stoma feedback, botulinum toxin injections, and silo placement.
- Surgical techniques were adapted based on the patient's evolving condition and complications.
- Successful complete abdominal reconstruction was achieved.
Implications:
- This case highlights the successful management of severe gastroschisis complications.
- Multidisciplinary and adaptive surgical strategies are crucial for favorable outcomes.
- Effective treatment can lead to full recovery, oral tolerance, and appropriate growth in affected infants.
Abstract:
Gastroschisis is a congenital malformation characterized by a visceral hernia and is one of the leading causes of short bowel syndrome in pediatric patients. This condition can result from congenital short bowel, but may also arise due to complications associated with the management of the abdominal wall defect. We present the case of a full-term newborn with simple gastroschisis who developed multiple gastrointestinal complications during initial management and was subsequently referred to our institution. On admission, the patient exhibited an open, frozen abdomen, enteroatmospheric fistulas, and loss of abdominal domain. Over the course of three months, various combined techniques were used, including primary intestinal sutures, jejunostomies with distal stoma feedback, botulinum toxin injections, and the construction of a polypropylene silo, with adjustments made based on the evolving complications. Ultimately, complete abdominal reconstruction was achieved. The patient's recovery was favorable, and he was discharged at five months of age with oral tolerance and appropriate weight and height gain.
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