1/71. Congenital hernia of the abdominal wall: a differential diagnosis of fetal abdominal wall defects. A 28-year-old woman was referred at 33 weeks of gestation with suspected fetal intestinal atresia. Sonography showed a large extra-abdominal mass on the right of the normal umbilical cord insertion. Following cesarean section at 36 weeks and immediate surgical treatment, the malformation was not definable either as an omphalocele or as gastroschisis. This reported case involves a previously undocumented malformation of the fetal abdominal wall described as a 'hernia' of the fetal abdominal wall. ( info) |
2/71. Fatal cardiac tamponade as a late complication of central venous catheterization: a case report. Central venous catheterization is a reliable technique in neonatal surgery. Nevertheless, the rate of mechanical catheter-related complications remains high. We report a neonate with gastroschisis in which the successful placement of a central venous catheter was followed later by a cardiac tamponade with a fatal outcome. This complication occurred without perforation of the cardiac wall. A similar finding has been reported in only one other pediatric patient. Vigilant observation is required in any neonate with a central venous line in place to prevent the occurrence of this life-threatening event. ( info) |
3/71. gastroschisis associated with bladder evisceration complicated by hydronephrosis presenting antenatally. We report here a case of gastroschisis associated with bladder evisceration and complicated by rapidly developing hydronephrosis diagnosed antenatally. The timing of delivery was determined by the hydronephrosis, associated bowel dilatation and polyhydramnios. The case highlights the need for continuing ultrasonographic surveillance of fetuses with gastroschisis to identify further associated complications which were hitherto absent but whose presence may influence the timing of delivery and neonatal care. ( info) |
4/71. Prolonged intestinal exposure to amniotic fluid does not result in peel formation in gastroschisis. The etiology of bowel wall changes in infants with gastroschisis remains unknown. Currently, debate focuses on the relative roles of amniotic fluid exposure versus that of intestinal ischemia. The authors report five cases of prenatally diagnosed gastroschisis in which the bowel was exposed to amniotic fluid for up to 21.3 weeks without developing any visible intestinal peel. These cases appear to minimize the role of prolonged amniotic fluid exposure in the development of bowel wall changes in gastroschisis. ( info) |
| The accurate prenatal diagnosis of anterior abdominal wall defects is important because it affects patient management and prognosis. The pathophysiology of each defect leads to key characteristics that make it possible to differentiate one entity from another. Among these features are the location of the defect in relation to cord insertion, the size and contents of the defect, and the associated anomalies. This article reviews the underlying defects, the characteristic ultrasound findings, the associated anomalies, and the prognosis of simple and complicated abdominal wall defects. The basic features of simple abdominal wall defects (i.e., omphalocele and gastroschisis) were used as the initial points of assessment. A comparison of the different features of these abnormalities and how they differ from one another resulted in the development of criteria that facilitated the understanding of the different ultrasound manifestations of these anomalies. ( info) |
| short bowel syndrome can present many complex management issues and may be complicated by various metabolic problems. D-lactic acidosis in the setting of short bowel syndrome has been described only rarely in children. A further case is presented with a review of typical clinical manifestations of D-lactic acidosis and reported management options. Early recognition and appropriate management is essential to avoid morbidity secondary to this complication of short bowel syndrome. Probiotic therapies may have an increasing role in prevention and management of this complication. ( info) |
7/71. Vanishing gut in infants with gastroschisis. Infants born with gastroschisis (GS) in association with intestinal atresia are well described, however, atresia to the extent where none or very little of the midgut remains has rarely been reported. In this paper we present one infant born with a GS defect in combination with total loss of the midgut and another with a tight GS defect with atresia of the proximal and distal midgut at the regions where the bowel had gone through the abdominal wall. On examining these and other case reports in the literature, we realised that there is a GS spectrum, at one end with simple, localised atresia with the rest of the gut exhibiting minimal vascular compromise and at the other a very small or no defect with absence of the entire midgut. ( info) |
8/71. Ulceration in an ileocolic anastomosis treated with ranitidin. The authors report the case of a child born with a gastroschisis and an ileal atresia. After surgery, only 100 cm small bowel and the distal one third of his colon remained. Perianastomotic ulcers developed 6 years later. These were treated successfully with ranitidin, a treatment not previously reported in the literature. The authors conclude that treatment with ranitidin was successful in a patient with an ulcer in an ileocolic anastomosis. ( info) |
9/71. Congenital colocutaneous fistula as presenting sign of prenatally closed gastroschisis. MATERIALS AND methods: An infant was born with a congenital colocutaneous fistula to the right of the base of the umbilicus, along with distal small bowel atresia. RESULTS: These findings produced a unique presentation of a prenatally closed gastroschisis with absorption of the extruded intestine. CONCLUSION: This child, like all five previously reported infants with prenatally closed gastroschisis, died from complications of short-gut syndrome. ( info) |
10/71. 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. ( info) |