We present the case of a patient with severe postoperative scarring from surgical treatment for gastroschisis, with the intestine located immediately under the dermal scar. Although many patients are unsatisfied with the results of scar repair treatment, few reports exist regarding severe or difficult cases involving the surgical repair of postoperative scar contracture. We achieved an excellent result via simulation involving graph paper drawings that were generated using computed tomography images as a reference, followed by dermal scar de-epithelialization. The strategy described here may be useful for other cases of severe postoperative scar contracture after primary surgery for gastroschisis.
Cicatrix* ; Contracture ; Gastroschisis* ; Humans ; Intestines

RATIONALE: The objective of the study was to describe the outcome in a series of patients with delayed primary closure of gastroschisis using a Preformed Spring-Loaded Silo Bag (PSLS).

METHODS: A prospective data collection and chart review were done all gastroschisis patients from May 2011 to April 2013. Eligible gastroschisis patients were applied with silo bag, gradual reduction of abdominal viscera and elective abdominal wall closure. The post- operative  outcomes  investigated  were:  infection  rate,  days  to immediate fascial closure, post-operative ventilatory period, post-operative  NPO  period  to  successful  enteral  feeding,  days  in  the NICU, days of hospital admission, development of post-operative complications, and mortality rate.

RESULTS: Thirty-four  gastroschisis  patients  were  admitted  from May  2011  to  April  2013,  of  whom  25  patients  qualified  for  the study.  Majority  of  the  patients  were  female,  preterm,  delivered vaginally, weighed <2kg admittted within the first 24hrs of life. 84% had prenatal ultrasound, less 50% were diagnosed correctly. 48% of mothers were less than 20 years old. Fascial closure rate was 88% (delayed abdominal closure done within 10 days). 72% were fed within 10 days after delayed abdominal wall closure. 52% were extubated within 24 hours. Average hospital stay was 35 days. Overall outcome: morbidity rate- 48%; home against medical advice (HAMA)-4%; mortality rate - 12%.

CONCLUSIONS: The use of PSLS bags for the delayed primary closure of gastroschisis appears to be a safe and beneficial.

Human ; Female ; Gastroschisis ; Length Of Stay ; Viscera ; Enteral Nutrition ; Mothers ; Abdominal Wall ; Prospective Studies ; Intensive Care Units, Neonatal ; Elective Surgical Procedures ; Morbidity ; Postoperative Period

BACKGROUND: The survival rate of newborns with severe congenital abdominal wall defects has increased. After successfully addressing life-threatening complications, it is necessary to focus on the cosmetic and functional outcomes of the abdominal wall. METHODS: We performed a chart review of five cases treated in our institution. RESULTS: Five patients, ranging from seven to 18 years of age, underwent the following surgical approaches: simple approximation of the rectus abdominis fascia, the rectus abdominis sheath turnover flap, the placement of submuscular tissue expanders, mesh repair, or a combination of these techniques depending on the characteristics of each individual case. CONCLUSIONS: Patients with severe congenital abdominal wall defects require individualized surgical treatment to address both the aesthetic and functional issues related to the sequelae of their defects.
Abdominal Muscles ; Abdominal Wall* ; Fascia ; Gastroschisis ; Hernia, Umbilical ; Hernia, Ventral ; Humans ; Infant, Newborn ; Rectus Abdominis ; Survival Rate ; Tissue Expansion Devices

No abstract available.
Gastroschisis*

Gastroschisis is a congenital abdominal wall defect that occurs at the immediate right of the umbilicus. Left-sided gastroschisis, which is located in the left periumbilical region, is extremely rare, as only 22 cases have been reported worldwide. Although most cases of gastroschisis are not complicated by other anomalies, extraintestinal anomalies are more commonly associated with left-sided gastroschisis than classic right-sided gastroschisis. In this report, we describe a case of left-sided gastroschisis complicated by cardiac anomalies. We also discuss the suggested theories of its pathogenesis and present a literature review. For patients with left-sided gastroschisis, we recommend evaluation of the associated anomalies because extraintestinal anomalies in the genitourinary, cardiovascular, or central nervous systems are more common in left-sided gastroschisis than in classic right-sided gastroschisis.
Abdominal Wall* ; Central Nervous System ; Gastroschisis* ; Hernia, Abdominal ; Hernia, Umbilical ; Humans ; Umbilicus

PURPOSE: Gastroschisis and omphalocele are major anterior abdominal wall defects. The purpose of this study was to analyze the clinical differences and mortalities of gastroschisis and omphalocele in Asan Medical Center. METHODS: A retrospective review of the medical records was conducted of 103 cases of gastroschisis and omphalocele from September 1989 to February 2013 in Asan Medical Center in Korea. RESULTS: There were 43 cases (41.7%) of gastroschisis and 60 cases (58.3%) of omphalocele. There was a female predominance in both gastroschisis (60.5%) and omphalocele (58.3%). The average gestational age at delivery was 36.7+/-0.4 weeks for both groups. The mean birth weights were 2,381.9+/-80.6 g for gastroschisis and 2,779.4+/-82.8 g for omphalocele (p=0.001). Mean maternal ages in the gastroschisis and omphalocele groups were 27.5+/-0.7 years and 30.5+/-0.7 years, respectively (p=0.002). Associated malformations were documented in 13 infants (30.2+/-) with gastroschisis and 46 infants (76.7+/-) with omphalocele (p<0.001). All of gastroschisis patients except one underwent surgery including 31 primary repairs and 11 staged repairs. Fifty-two infants with omphalocele underwent surgery-primary repair in 41 infants and staged repair in 11 infants. Among 103 cases, 19 cases (18.4%) expired. Mortality rates of gastroschisis and omphalocele were 23.3% (10/43 cases) and 15.0% (9/60 cases), respectively (p=0.287). The main causes of death were abdominal compartment syndrome (6/10 cases) in gastroschisis, respiratory failure (4/9 cases) and discharge against medical advice (4/9 cases) in omphalocele. CONCLUSION: Gastroschisisis was associated with younger maternal age and lower birth weight than omphalocele. Associated malformations were more common in omphalocele. The mortality rates did not make a statistical significance. This might be the improvement of treatment of cardiac anomalies, because no patient died from cardiac dysfunction in our study. Furthermore, abdominal compartment syndrome might be the main cause of death in gastroschisis.
Abdominal Wall ; Birth Weight ; Cause of Death ; Chungcheongnam-do ; Female ; Gastroschisis* ; Gestational Age ; Hernia, Umbilical* ; Humans ; Infant ; Intra-Abdominal Hypertension ; Korea ; Maternal Age ; Medical Records ; Mortality ; Prognosis* ; Respiratory Insufficiency ; Retrospective Studies

Most infants with repaired gastroschisis develop normally and remain in good health. About 10% of patients with gastroschisis have other malformations. We report a case of choledocholithiasis and intestinal malrotation in an adolescent with repaired gastroschisis. A 17-year-old girl presented with fever, jaundice, and abdominal pain. She had undergone an operation to repair gastroschisis at birth. Physical examination revealed icteric sclera, a tight abdominal wall, and a longitudinal surgical scar at the midline. An abdominal computed tomography scan revealed a round calcifying lesion near the pancreas and a midline-positioned liver and gallbladder. Absence of the retroperitoneal duodenum and the anterior and left-sided position of the superior mesenteric vein compared with the superior mesenteric artery were observed. Results of abarium examination revealed intestinal malrotation. Endoscopic retrograde cholangiopancreatography revealed diffuse dilatation of the biliary trees and a malpositioned gallbladder. A single stone was removed by using a basket. The clinical symptoms improved after the patient underwent endoscopic retrograde cholangiopancreatography.
Abdominal Pain ; Abdominal Wall ; Adolescent* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis* ; Cicatrix ; Dilatation ; Duodenum ; Female ; Fever ; Gallbladder ; Gastroschisis* ; Humans ; Infant ; Jaundice ; Liver ; Mesenteric Artery, Superior ; Mesenteric Veins ; Pancreas ; Parturition ; Physical Examination ; Sclera

OBJECTIVE: The aim of this study is to analyze the perinatal courses, fetal treatment and postnatal outcomes of fetal gastroschisis. METHODS: A retrospective review of the medical records of 35 cases with a prenatal diagnosis of gastroschisis was conducted between March 1997 and April 2007. RESULTS: Twenty-eight fetuses were followed up and 17 fetuses of them were born alive. Chromosomal study was performed in 22 fetuses and no abnormality was detected in them. Associated anomalies except for gastrointestinal anomalies were found in 12 (34.2%) cases: amniotic band syndrome (n=8), scoliosis (n=6), cleft lip (n=1), hydrops (n=1), hydrocephalus (n=1), acrania (n=1). In 4 fetuses, amnioinfusion and amnioexchange were performed simultaneously for treatment. Four cases (23.5%) were delivered by cesarean section. All neonates received corrected operation immediately after birth and 8 (47.1%) of them had postoperative complications. Three of them were died and the overall survival rate was 82.4%. The average length of hospital stays for the survivors was 36 days (2~210days). CONCLUSION: Fetal gastroschisis diagnosed prenatally has a good prognosis and high survival rates. The result of this study was not different from that of preexisting studies and will be a useful guide in counseling parents with a prenatal diagnosis of gastroschisis.
Amniotic Band Syndrome ; Cesarean Section ; Cleft Lip ; Counseling ; Edema ; Female ; Fetal Therapies ; Fetus ; Gastroschisis ; Humans ; Hydrocephalus ; Infant, Newborn ; Length of Stay ; Medical Records ; Neural Tube Defects ; Parents ; Parturition ; Perinatal Care ; Postoperative Complications ; Pregnancy ; Prenatal Diagnosis ; Prognosis ; Retrospective Studies ; Scoliosis ; Survival Rate ; Survivors

PURPOSE: Ibuprofen is a non steroidal anti-inflammatory drug used for treating fever and pain including headache, arthralgia, and back pain. There is scarce information on the safety of ibuprofen associated with fetal anomaly when used early in pregnancy. Epidemiology studies have suggested that use of NSAIDs, including ibuprofen, during pregnancy may increase the risk of cardiac defects and gastroschisis. The aim of the study was to evaluate fetal outcomes among pregnant women who were unintentionally exposed to ibuprofen in early pregnancy. METHODS: Total 381 pregnant women who were unintentionally exposed to ibuprofen during early pregnancy were prospectively followed up. In addition, 643 age and gravity matched pregnant women not exposed to any potential teratogenic agent during pregnancy were recruited as controls. Patients were followed-up until delivery or loss to follow-up. Newborns were examined in order to identify any major congenital malformation. RESULTS: Mean age of exposed women was 31.2+/-3.4 years, with a mean number of previous pregnancies of 2.3+/-1.2 and mean gestational weeks at exposure of 4.4+/-2.2. All gestations were confirmed by ultrasonography. Of exposed women, 17 (5.6%) had spontaneous abortions, 16 were on- going pregnancies, 1 had an intra-uterine fetal death, 21 artificial abortion and 55 cases were lost to follow-up. Therefore, 271 pregnancies unintentionally exposed to ibuprofen were evaluated, each delivering a singleton baby. Three babies had congenital anomalies: one had unilateral hydronephrosis, another baby was born with a unilateral inguinal hernia. The last baby was born with unilateral kidney dysplasia with megaureter. In the control group, 6 babies were born with major malformations [1.11% vs. 1.31% (P=0.552, OR: 0.841, 95% CI: 0.2 to 3.4)]. CONCLUSION: These preliminary results suggest that the ibuprofen may not be a major human teratogen.
Abortion, Spontaneous ; Anti-Inflammatory Agents, Non-Steroidal ; Arthralgia ; Back Pain ; Female ; Fetal Death ; Fever ; Follow-Up Studies ; Gastroschisis ; Gravitation ; Headache ; Hernia, Inguinal ; Humans ; Hydronephrosis ; Ibuprofen ; Infant, Newborn ; Kidney ; Lost to Follow-Up ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, First ; Pregnant Women ; Prospective Studies

PURPOSE: The authors applied fetal stabilization and evaluated its efficacy as a therapeutic modality in the management of several congenital anomalies that can lead to perinatal respiratory distress, such as a congenital diaphragmatic hernia (CDH), large cervical lymphangioma or gastroschisis, etc. METHODS: Between Oct. 2000 and Dec. 2004, 12 newborns, with a congenital diaphragmatic hernia or gastroschisis, were observed and fetal stabilization was applied to 4 neonates. Their clinical characteristics were then retrospectively reviewed. The protocol of this procedure was as followed, (1) monitoring of the fetal respiratory movement and heart beat using Doppler ultrasonography, (2) the intravenous administration of morphine (20 to 30 mg) and diazepam (5 mg) to the mother, (3) proceed to a cesarean section when any interruptions in the fetal movement were confirmed, (4) an intravenous injection of a pancuronimum (0.5 mg) through the umbilical vein, (5) an immediate tracheal intubation before disruption of the placenta, (6) clamping of the umbilical cord, (7) attempt a mechanical ventilation after delivery, (8) maintain percutaneous intravenous catheterization (PIC) and (9) evaluation of the neonate. RESULTS: Of the 10 neonates with a CDH and the 2 with gastroschisis, fetal stabilization was applied to 3 CDH and 1 gastroschisis neonates, respectively. The survival rates were 85.7% that of conventional therapy, 66.7% for fetal stabilization in the CDH neonates and 100% for those with gastroschisis. Relatively, in those with a CDH where fetal stabilization was applied, large defects were observed and they were diagnosed at an earlier period, which could affect the mortality. CONCLUSION: In our experience, fetal stabilization seems to be useful as another alternative therapeutic modality for the control of respiratory distress in the management of a CDH and gastroschisis. However, further experiences with more clinical results will be required
Administration, Intravenous ; Catheterization ; Catheters ; Cesarean Section ; Constriction ; Diazepam ; Female ; Fetal Movement ; Gastroschisis ; Heart ; Hernia, Diaphragmatic ; Humans ; Infant, Newborn ; Injections, Intravenous ; Intubation ; Lymphangioma ; Morphine ; Mortality ; Mothers ; Placenta ; Pregnancy ; Respiration, Artificial ; Retrospective Studies ; Survival Rate ; Ultrasonography, Doppler ; Umbilical Cord ; Umbilical Veins