Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 3

Clinical History:
The patient was a newborn full term male with an anterior abdominal wall defect diagnosed via prenatal ultrasound.

Clinical Physical Exam:
A gastroschisis defect was present with the stomach, small bowel and appendix protruding out of the abdomen. Thin extremities with arthrogrypotic fourth finger contractures bilaterally were also noted.

Image 1

Clinical Labs:
The patient had a normal AFP and chromosome survey.

Clinical Differential Diagnosis:
Gastroschisis

Imaging Findings:
A preoperative AP chest x-ray demonstrated gastroschisis with the bowel loops on the right side exterior to the baby.

Image 2

Imaging Differential Diagnosis:
Gastroschisis

Operative Findings:
On the first day of life the defect was initially repaired. The stomach and small bowel were dilated due to there being colonic atresia just distal to the cecum. The distal colon was small in caliber. A silo for the abdominal contents was constructed using sterile silastic sheet material and Teflon mesh and sterile gauze and saran wrap. A gastrostomy and cecostomy were also placed.

Image 3

Pathological Findings:
None

Final Diagnosis:
Gastroschisis, Colonic Atresia, Post-Op GI Dysmotility, Arthrogryposis

Follow-up and Prognosis:
The silo was progressively reduced, returning the abdominal viscera to the abdominal cavity. The patient's cecum was eventually reanastomosed to his colon. The patient had difficulty with his total parenteral nutrition (TPN), resulting in TPN induced liver failure. The patient also had persistent GI dysmotility.

Image 4

Similar Cases:
Case 19, Case 25, Case 52

References:

• Paediapedia
• WebPath

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