Marinovic Vesna Milojkovic, Lukac Marija Lukac, Mikovic Zeljko, Grujic Blagoje, Stojanovic Aleksandra, Sabbagh Dalibor, Samardžija Gordana
Ann Ital Chir. 2016;87:263-7.
Gastroschisis with prenatal gastric perforation and intestinal stenosis is a rare and serious anomaly. although there are several case reports, no case series exists to suggest the prognosis for these infants.
In this report a case of gastroschisis with gastric perforation and jejunal stenosis in male newborn is presented with literature review. The stomach, small bowel and the part of the colon were herniated through the abdominal wall defect. A large perforation site at the anterior wall of fundus and a thin fibrous strip that causing stenosis of jejunum was found.
Gastrorraphy was performed. Stenosis of jejunum was resected and t-t anastomosis was performed, followed by primary fascial closure.
The prenatal sonographic finding of bowel or gastric perforation are variable. Antenatal bowel dilatation and in particular intraabdominal bowel dilatation is prognostically useful for detection of patients with worse outcome. The absence of bowel dilatation cannot fully exclude complex patients. Early restoration of bowel continuity using primary anastomosis and primary abdominal wall closure are not associated with prolonged time for full enteral feeding and length of hospital stay.
We have presented the first detailed report of surgical intervention and outcomes in case of gastroschisis with prenatal gastric perforation and congenital jejunal stenosis. Early restoration of bowel continuity using primary anastomosis and primary abdominal wall closure is recommended here. More research should be focused to predict complex gastroschisis and to improve prenatal diagnosis and postnatal management, without a significant increase in morbidity and mortality.
Gastroschisis, Gastric perforation, Stenosis of jejunum.
合并产前胃穿孔及肠狭窄的腹裂是一种罕见且严重的畸形。尽管有几例病例报告，但尚无病例系列研究提示这些婴儿的预后情况。
本报告介绍了一名患有胃穿孔及空肠狭窄的男性新生儿腹裂病例，并进行了文献复习。胃、小肠及部分结肠经腹壁缺损处疝出。发现胃底前壁有一个大的穿孔部位以及一条导致空肠狭窄的薄纤维带。
进行了胃修补术。切除空肠狭窄段并进行了端-端吻合，随后进行了一期筋膜缝合。
产前超声检查发现的肠或胃穿孔表现多样。产前肠扩张，尤其是腹腔内肠扩张，对预测预后较差的患者具有预后价值。无肠扩张并不能完全排除病情复杂的患者。采用一期吻合和一期腹壁关闭尽早恢复肠道连续性，与完全肠内喂养所需时间延长及住院时间延长无关。
我们首次详细报告了合并产前胃穿孔及先天性空肠狭窄的腹裂病例的手术干预及结果。本文推荐采用一期吻合和一期腹壁关闭尽早恢复肠道连续性。应开展更多研究以预测复杂腹裂情况，并改善产前诊断及产后管理，同时不显著增加发病率和死亡率。
腹裂；胃穿孔；空肠狭窄
