This is a case report of a rare complication of a chest drain inserted for postoperative pneumothorax, which resulted in cardiac perforation in a child with congenital heart disease. Ethical clearance for this report was received from the Port Moresby General Hospital management in the absence of a hospital-appointed Ethics Committee.

In the absence of a neonatal intensive care unit (NICU) and total parenteral nutrition (TPN) gastroschisis management is challenging (1). If surgical closure is not done within the first 6 hours post partum, impending complications intervene, which then prevent a good outcome in such infants. The defect near the right side of the umbilicus provides the avenue for the intra-abdominal contents to protrude into the amniotic cavity in intra-uterine life and visceral exposure to the external environment increases the morbidity after delivery. The tight 2.5-5 cm bottleneck diameter provides further complications if not surgically corrected immediately. The prognosis has improved over the years and in well-set-up hospitals more than 95% have survived. Appropriate antenatal diagnosis (2) and early neonatal surgical intervention have improved the survival of these neonates. Blood investigation to assist with the antenatal diagnosis, such as amniotic fluid beta-endorphin analysis (3) and alpha-fetoprotein, assists in anticipating severe complications. Prevention of complications such as mesenteric infarct, fluid and electrolyte imbalance, necrotizing enterocolitis (NEC) and raised intra-abdominal compartment syndrome (RIACS) (2) and providing nutritional support have resulted in the good outcome of these cases. In the absence of accurate radiological diagnosis and back-up support services such as NICU and TPN, it is challenging to manage such infants. In a country where subspecialties are lacking it is very difficult to reassure the parents of a gastroschisis patient. Most of them do not make it. The following two case reports highlight some of these limitations and the alternative measures that can be taken to address the issues.