1/15. Prenatally detected gastroschisis presenting as jejunal atresia due to vanishing bowel.A case of gastroschisis complicated by vanishing bowel and presenting as jejunal atresia is reported that is uniquely different from previously reported cases. Following delivery, complete closure of the abdominal wall with a small fascial defect was observed. Complete healing of this fascial defect was observed at 1 month of age.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/15. Transabdominal amnioinfusion to avoid fetal demise and intestinal damage in fetuses with gastroschisis and severe oligohydramnios.BACKGROUND/PURPOSE: Despite dramatic improvement in survival rate for neonates with gastroschisis, significant postoperative morbidity and a low mortality rate still occur. Furthermore, even in recent publications, some fetal death has been reported. Does this mean that antenatal diagnosis of gastroschisis is a missed opportunity? In fact, decreased amniotic fluid (AF) volume is observed in some fetuses with gastroschisis. However, oligohydramnios is associated with an increased risk of fetal suffering. When severe oligohydramnios is observed, intrapartum amnioinfusion, to restore AF volume, may help avoid fetal complications. methods: Two fetuses with gastroschisis and severe oligohydramnios were treated antenatally with amnioinfusion of saline solution. In one case, fetal heart beat decelerations were observed at 27 weeks' gestation among with the oligohydroamnios and serial transabdominal amnioinfusions were performed. In the second case, severe oligohydramnios was observed at 31, weeks and an amnioinfusion was performed. The 2 babies were delivered at 31 and 34 weeks, respectively. RESULTS: In both cases, exteriorized bowel was nearly normal at birth, and primary closure could be performed. Outcome was favorable, and they were discharged home on day 43 and day 54, respectively. CONCLUSIONS: Because fetuses with gastroschisis and oligohydramnios are part of a particular high-risk group, serial ultrasound examination and computerized fetal heart beat monitoring are necessary during the third trimester. In selected cases of gastroschisis associated with severe oligohydramnios, serial amnioinfusion may be required.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
3/15. Left-sided gastroschisis: two case reports in Ratchaburi Hospital.Left-sided gastroschisis has rarely been reported. From August 1987 to April 1998, 73 cases of gastroschisis were treated at the Pediatric Surgical Unit, Department of Surgery, Ratchaburi Hospital. The abdominal wall defect of only 2 cases occurred on the left side of the umbilicus. The 2 cases of left-sided gastroschisis were girls and were successfully treated by primary fascial closure. After 7 and 1 year follow-up the patients remain asymptomatic.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
4/15. Acute bowel perforation in a fetus with gastroschisis.gastroschisis is a congenital anomaly with a reported incidence of 1 in 10,000 live births. Although prenatal diagnosis is more common with the widespread use of biochemical markers and obstetric ultrasound, the role of ultrasound in the identification of the fetus that might need early intervention has not been established. Acute bowel perforation was diagnosed by ultrasound at 34 weeks gestation in a fetus with gastroschisis. An immediate cesarean section was performed, followed by repair with primary closure. The neonatal outcome was favorable. The post-partum findings, including bowel pathology, confirmed the antenatal diagnosis. Acute bowel perforation can be diagnosed antenatally. Immediate intervention, before further bowel injury occurs, might enhance the ability of the surgeon to perform primary closure and obtain a favorable outcome.- - - - - - - - - - ranking = 2keywords = closure (Clic here for more details about this article) |
5/15. Unsatisfactory experience with 'minimal intervention management' for gastroschisis.PURPOSE: The authors report, for cautionary reasons, their trial with "minimal intervention management" for gastroschisis. After the successful innovative experience with this approach, which Bianchi and Dickson described, they utilized it in 4 consecutive patients. methods: In the delivery room a plastic bag was placed over the intestines, which rested in a dependent position to reduce edema. The stomach was decompressed and the patients kept warm. Intravenous fluid at a maintenance rate was given. After about 5 hours an attempt at closure was undertaken in the newborn intensive care unit without anesthesia. An assistant lifted the anterior abdominal wall by applying upward traction on the umbilical cord. Over about 25 minutes the intestines were placed in the coelom, which was closed with a single suture. RESULTS: The outcome was uncomplicated in the first of 4 consecutive patients. The second patient had abdominal compartment syndrome requiring a silo and subsequent resection and has chronic malabsorption 16 months later. The third had an enterocutaneous fistula at 5 weeks that required a small bowel resection. Bedside closure was abandoned in the final case because too much resistance was encountered. She underwent primary repair in the operating room and eventually died of sepsis with intestinal dysmotility. CONCLUSIONS: The "minimal intervention approach" can be effective in some patients who have gastroschisis. This experience suggests that selection criteria are needed before this method can be recommended.- - - - - - - - - - ranking = 2keywords = closure (Clic here for more details about this article) |
6/15. gastroschisis complicated by midgut atresia, absorption of bowel, and closure of the abdominal wall defect.We present a case of gastroschisis that was associated with progressive resorption of the extra-abdominal bowel loops and dilation of intra-abdominal bowel loops. After preterm delivery at 32 weeks, a small paraumbilical remnant was present. There was complete atresia of most of the jejunum, ileum, cecum, and the proximal half of the transverse colon. At laparotomy, the jejunum was anastomosed to the transverse colon. The neonate developed short gut syndrome and eventually received a liver and intestinal transplant.- - - - - - - - - - ranking = 4keywords = closure (Clic here for more details about this article) |
7/15. Testicular proximity can induce gubernaculum formation after delivery.PURPOSE: This paper presents the hypothesis that after delivery as late as 38 weeks' gestation, a testis placed near the internal ring can induce the formation of a gubernaculum and undergo a belated but otherwise normal descent. methods: Two boys with a gastroschisis were each born with one of their testes prolapsed through the defect. The testis was sutured just lateral to the deep inferior epigastric vessels at the time of the primary closure of the gastroschisis. RESULTS: One boy born at 34 weeks had his left testis prolapsed through a left-sided gastroschisis defect. At 3 months, he was admitted to the hospital with a large left inguinal hernia. The repair was complicated by the presence of a large mass of jellylike tissue extending through the internal ring to the upper scrotum. A second boy was born at 38 weeks' gestation. The testis made its way uneventfully into the right hemiscrotum by 10 months of age. CONCLUSION: These cases suggest that testicular proximity is a critical factor in the formation of the gubernaculum and that the testis can induce the formation of the gubernaculum as late as 38 weeks gestation.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
8/15. Prenatal closure of abdominal defect in gastroschisis: case report and review of the literature.With the routine use of fetal imaging studies during prenatal care, increased numbers of unusual intrauterine events are now detected. Prenatal closure of the abdominal defect in gastroschisis is an example. We report a 34 5/7-week stillborn who had prenatal closure of a ventral abdominal wall defect, which had been seen earlier on fetal ultrasound examination. Two ultrasound examinations performed at 15 1/7 weeks and 19 1/7 weeks showed a mass of exteriorized bowel that herniated through the abdominal defect, just to the right of the umbilical cord. At 30 1/7 weeks, no exteriorized bowel was seen, but thickened and dilated intraabdominal bowel was identified. No abdominal defect or exteriorized bowel was found at autopsy. There was a severely dilated proximal jejunum with the absence of the rest of the small intestine and the right side of the colon. The remaining left side of the colon was small and blind proximally. Six similar isolated examples have been reported since 1991. Prenatal closure of an abdominal defect was associated with long-segment atresia of the midintestine in each case. We believe that the spontaneous closure of this abdominal defect was associated with atresia and resorption of exteriorized bowel. It is likely some of the cases of long-segment atresia may in fact be associated with closed gastroschisis.- - - - - - - - - - ranking = 8keywords = closure (Clic here for more details about this article) |
9/15. Unusual presentations of gastroschisis.gastroschisis is a defect of the ventral abdominal wall nearly always located to the right of the umbilicus. A relatively low incidence of associated anomalies exists with the most common being nonduodenal intestinal atresia occurring in 10 per cent of patients. Although multiple hypotheses have been proposed the pathogenesis of gastroschisis is unproven and controversial. Herein we describe four infants with rare presentations of gastroschisis: one infant with true left-sided gastroschisis and three infants with unusual patterns of intestinal atresia. At present there is a female preponderance of left-sided gastroschisis as reported in the world literature (five female:two male). These cases illustrate the anatomic spectrum of gastroschisis as well as support intrauterine spontaneous closure of the abdominal wall defect as an etiology for midgut atresia.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
10/15. Prenatally closed gastroschisis with midgut atresia.Spontaneous prenatal closure of gastroschisis (GS) is rare and usually associated with atresia of the midgut. We describe a case of GS diagnosed at 20 weeks' gestation that resolved spontaneously in utero. At delivery the infant had an ileus. A laparotomy with a jejunocolostomy was performed, but she died at 2 months of age due to complications of total parenteral nutrition.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
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