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"Bucket handle" avulsion of intestine in gastroschisis
L A Dinatti1, D P Meagher, L A Martinez-Frontanilla
1Department of Surgery, Children's Hospital, CO.
Insights
Severe gastroschisis cases can lead to significant midgut loss during cesarean delivery. Prompt surgical intervention and nutritional support are crucial for infant survival and long-term outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastroenterology
Background:
- Gastroschisis is a congenital abdominal wall defect.
- Cesarean delivery in fetuses with gastroschisis poses risks.
- Midgut avulsion is a rare but severe complication.
Observation:
- Two infants with gastroschisis experienced midgut avulsion during cesarean section.
- Remaining small bowel length was 12 cm and 20 cm, with intact ileocecal valves.
- Both infants underwent cutaneous enterostomy and subsequent anastomosis.
Findings:
- One child achieved total enteral feeding after prolonged intravenous support.
- The second infant continues to require partial parenteral nutrition.
- Outcomes highlight the challenges of extensive small bowel loss.
Implications:
- Cesarean extraction of fetuses with gastroschisis requires careful surgical technique to minimize fetal injury.
- Management of extensive midgut loss necessitates specialized neonatal surgical and nutritional care.
- These cases underscore the critical need for prenatal diagnosis and planning for gastroschisis.
Abstract:
Two infants with gastroschisis had most of the midgut avulsed during cesarean section. There was only 12 and 20 cm of small bowel remaining, with an intact ileocecal valve in each case. Cutaneous enterostomy followed by anastomosis was done in both patients. The first child is 4 years old and is now on total enteral feedings after prolonged intravenous support. The second infant is still on partial parenteral nutrition. The cases illustrate the vulnerability of the fetus with gastroschisis during extraction by cesarean section.