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Boletín Clínico de la Asociación Médica del Hospital Infantil del Estado de Sonora

2023, Number 2

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Bol Clin Hosp Infant Edo Son 2023; 40 (2)

Complex gastroschisis associated with necrosis of the cecum, meconium ileus and atresia of the ascending colon. Case report

Pacheco-Barete CF, López-Cruz G, Leyva-Bohórquez PC, Rodríguez-García J, López-Días AV, Bravo-Torres M, Martínez-Hernández Y, Coronado-García, R, Rosas-Paz NE, López-Días PS, Reyes-Gómez U, Reyes-Hernández KL, Quero-Hernández A

Language: Spanish
References: 25
Page: 53-58
PDF size: 234.62 Kb.


ABSTRACT

Complex gastroschisis defines cases with abdominal wall defect associated with intestinal atresia, stenosis, volvulus, necrosis, or perforation. In this work we present the clinical case of female, 37 weeks gestation.
Heredofamilial history, no relevant data. Prenatal history: G1, A0, diagnosed with gastroschisis in the first trimester. Postnatal history: born via abdominal delivery, ++ meconium-stained amniotic fluid, flaccid, no respiratory effort, Silverman-Andersen 4, APGAR 6/8, weight 2,720 grams, length 48 cm, head circumference 32 cm, chest circumference 26 cm, abdominal circumference 26 cm, foot length 7 cm. Current condition: developed meconium aspiration syndrome and complex gastroschisis at birth. Diffuse infiltrates on chest X-ray. Surgical findings: colonic atresia with transmural necrosis of cecal wall, including the vermiforme cecal appendix and ileocecal valve. Thick, adherent meconium pellets in the terminal ileum. Ileostomy was performed to facilitate meconium management through enemas. At 14 days, abdominal plasty and ileocolic anastomosis were performed without complications. Oral administration of acetylcysteine resumed after 5 days and was discontinued at one month of age without complications. Complementary studies and follow- up: weat electrolytes ruled out cystic fibrosis, and neonatal screening was normal. Current follow-up at 1 year and 6 months shows. Weight within normal limits. Low height, under surveillance. Developmental delay, so she is included in an early stimulation program. Complex gastroschisis requires multiple surgeries and is associated with higher morbidity and mortality than simple gastroschisis. Timely management can change the morbidity outcome.


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