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

Case 19

Clinical History:
Newborn full term female born at an outside hospital. A diagnosis of omphalocele was made clinically and the patient was transferred to our institution.

Clinical Physical Exam:
Initial examination upon transfer revealed the child had a gastroschisis rather than an omphalocele with stomach and small bowel exposed through an opening on the right side of the umbilicus.

Image 1

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Gastroschisis

Imaging Findings:
A preoperative chest film showed the gastroschisis defect.

Image 2

Imaging Differential Diagnosis:
Gastroschisis

Operative Findings:
The patient was taken to the operating room immediately after transfer. An attempt was made to primarily reduce the bowel into the abdomen but this was not possible without undue tension. No obvious atresias were noted in the bowel which was moderately edematous and erythematous. A small Meckel diverticulum was present but was not excised. The abdominal opening was enlarged. A prosthetic silo of Silon (reinforced silastic) was created by sewing the Silon to the fascia on either side of the incision. The silo was then wrapped in Kerlix cotton gauze and sterile Silastic drapes.

Image 3

Pathological Findings:
None

Final Diagnosis:
Gastroschisis

Follow-up and Prognosis:
The patient underwent serial mesh tightening and on day of life eight underwent removal of the silo and final closure of the gastroschisis. The patient subsequently did well.

Image 4

Similar Cases:
Case 3, Case 25, Case 52

References:

• Paediapedia
• WebPath

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