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CASE REPORT
Year : 2019  |  Volume : 32  |  Issue : 4  |  Page : 1227-1228

Complex gastroschisis with gangrene gut: a rare case


Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India

Date of Submission29-Apr-2018
Date of Decision01-Jul-2018
Date of Acceptance05-Jul-2018
Date of Web Publication31-Dec-2019

Correspondence Address:
Aditya P Singh
Pediatric Surgery, Near The Mali Hostel, Main Bali Road, Falna, Pali, Rajasthan - 306 116
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_166_18

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  Abstract 


Gastroschisis is a congenital abdominal wall defect. Proposed classification of this malformation is simple if isolated or complex in the presence of coexisting intestinal anomalies at birth such as intestinal atresia, stenosis, perforation, necrosis, or volvulus. We report a case of gastroschisis with gangrene of intestine. At the time of surgery, we found a small abdomen wall defect through which intestine was herniating. In our view, it was the small defect that caused gangrene in the gut. Gangrene gut was resected and end-to-end anastomosis was done. The patient died owing to septicemia.

Keywords: complex, gastroschisis, small defect


How to cite this article:
Garg D, Singh AP, Gupta AK, Barolia DK. Complex gastroschisis with gangrene gut: a rare case. Menoufia Med J 2019;32:1227-8

How to cite this URL:
Garg D, Singh AP, Gupta AK, Barolia DK. Complex gastroschisis with gangrene gut: a rare case. Menoufia Med J [serial online] 2019 [cited 2020 Jun 6];32:1227-8. Available from: http://www.mmj.eg.net/text.asp?2019/32/4/1227/274222




  Introduction Top


Gastroschisis is a congenital abdominal wall defect most often situated to the right of the umbilicus, accounting for 1–5 per 10 000 births [1],[2]. Gastroschisis is classified into simple and complex gastroschisis. Complex gastroschisis is associated with coexisting intestinal anomalies such as intestinal atresia, stenosis, perforation, volvulus, or necrosis of intestine. Incidence of complex gastroschisis as high as 25% of total cases of gastroschisis [3].

We are presenting a case of complex gastroschisis associated with gangrene of the intestine. At surgery, we did not find any cause of gangrene except a very small defect.


  Case Report Top


A new born male child presented to the emergency department with abdominal wall defect. Patient weight was 1800 g and was preterm (36 weeks), delivered by cesarean section. On examination, the whole of the small intestine was herniating outside the abdomen and was black. Patient was admitted and prepared for surgery. Fluid loss was corrected, and gastric decompression was done by nasogastric tube. After appropriate resuscitation, surgery was done. After intubation, patient was examined carefully. During the surgery, we found the small gut was dilated and gangrenous, except some proximal and distal portions. Intestine was herniating out through a full-thickness small abdominal wall defect. There was no associated visceral malformation present. Gangrenous intestine was resected from ileum to ileocecal junction [Figure 1], and end-to-end anastomosis was done in between proximal ileum and ascending colon. Abdomen closure was done primarily [Figure 2]. Postoperatively, the patient was managed in neonatal ICU on ventilator. The patient died owing to septicemia and ventilator associated pneumonia on fifth postoperative day.
Figure 1: Excised specimen of gangrenous intestine.

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Figure 2: Defect was enlarged and for primary closure.

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  Discussion Top


Gastroschisis is an abdominal wall abnormality that results in herniation of bowel and other abdominal contents. The term 'complex' gastroschisis was first proposed by Molik et al. [4] who divided these infants into two different risk categories, 'complex' and 'simple,' and demonstrated that these are two clinically distinct subsets of infants with different hospital courses. This classification was supported by more recent studies [3] demonstrating that infants with complex defects (intestinal atresia, perforations, necrosis, and volvulus) are more likely to require extensive hospital resources and have poorer survival.

Ideal treatment of such anomalies would consist of safe primary closure of the anterior abdominal wall with the establishment of the intestinal continuity by primary anastomosis. Unfortunately, this scenario is rarely feasible [5]. Alternative treatment options may consist of primary, delayed primary, or staged silo closure of the anterior abdominal wall by leaving the atresia undisturbed or creating a stoma with the correction of intestinal atresia after few weeks [6].

The most common complication in the management of gastroschisis is the infectious ones, being correlated with the initial status of the patient. The presence of prematurity, low birth weight, or complex gastroschisis have been recognized as factors associated with worse outcome [4],[7]. The patient was managed on ventilator after surgery. The most important risk factors for the development of ventilator associated pneumonia include prematurity, low birth weight, prolonged duration of mechanical ventilation, enteral feeding, and invasive devices such as umbilical catheters [8]. In our case, patient had septicemia owing to the presence of gangrene in the small intestine. In our view, gangrene of intestine occurred owing to a small abdominal wall defect. In 1998, Bianchi and Dickson [9] described elective delayed midgut reduction without anesthesia or sedation in the incubator in the neonatal surgical unit.


  Conclusion Top


A small abdominal wall defect in the case of gastroschisis may cause gangrene of herniating contents.

Acknowledgements

The authors thank Dr Neelam Dogra, MD in Anaesthesia, Senior Professor, SMS Medical College Jaipur.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wilson RD, Johnson MP. Congenital abdominal wall defects: an update. Fetal Diagn Ther 2004; 19:385–398.  Back to cited text no. 1
    
2.
Mastroiacovo P, Lisi A, Castilla EE. The incidence of gastroschisis: research urgently needs resources. BMJ 2006; 332:423–424.  Back to cited text no. 2
    
3.
Abdullah F, Arnold MA, Nabaweesi R, Fischer AC, Colombani PM, Anderson KD, et al. Gastroschisis in the United States 1988-2003: analysis and risk categorization of 4344 patients. J Perinatol 2007; 27:50–55.  Back to cited text no. 3
    
4.
Molik KA, Gingalewski CA, West KW, Rescorla FJ, Scherer LR, Engum SA, et al. Gastroschisis: a plea for risk categorisation. J Pediatr Surg 2001; 36:51–55.  Back to cited text no. 4
    
5.
Snyder CL, Miller KA, Sharp RJ, Murphy JP, Andrews WA. Holcomb III GW, et al. Management of intestinal atresia in patients with gastroschisis. J Pediatr Surg 2001; 36:1542–1545.  Back to cited text no. 5
    
6.
Ledbetter DJ. Gastroschisis and omphalocele. Surg Clin N Am 2006; 86:249–260.  Back to cited text no. 6
    
7.
Singh SJ, Fraser A, Leditschke JF, Spence K, Kimble R, Dalby-Payne J, et al. Gastroschisis: determinants of neonatal outcome. Pediatr Surg Int 2003; 19:260–265.  Back to cited text no. 7
    
8.
Khattab AA, El-Lahony DM, Soliman WF. Ventilator-associated pneumonia in the neonatal intensive care unit. Menouf Med J 2014; 27:73–77.  Back to cited text no. 8
    
9.
Bianchi A, Dickson AP. Elective delayed reduction and no anaesthesia: 'minimal intervention management' for gastroschiasis. J Pediatr Surg 1998; 33:1338–1340.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

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