Oyachi Noboru, Numano Fuminori, Shinohara Tamao, Murakami Yasushi, Nemoto Atsushi, Naito Atsushi
Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Kofu, Yamanashi, 409-8506, Japan.
Department of Neonatology, Yamanashi Prefectural Central Hospital, Kofu, Japan.
Surg Case Rep. 2024 Oct 9;10(1):235. doi: 10.1186/s40792-024-02028-z.
Gastroschisis is a rare congenital anomaly in which abdominal organs herniate through a defect in the abdominal wall. Managing gastroschisis in extremely low birth weight (ELBW) infants presents significant challenges because of their immature physiologies and increased risk of complications.
This report discusses the case of a female ELBW infant born via an emergency cesarean section at 29 weeks of gestation, weighing 768 g, who had a prenatal diagnosis of gastroschisis. Postnatal management included immediate surgical intervention using a hand-made silo manufactured from expanded polytetrafluoroethylene (ePTFE) sheets that were sutured to the patient's abdominal wall to accommodate her small abdominal cavity and preserve mesenteric blood flow. Necrotizing enterocolitis with bowel perforation emerged as a complication, which led to the excision of a 10 cm segment of the ileum and the creation of an ileostomy. The infant experienced insufficient weight gain and liver dysfunction. However, she was eventually discharged on day 142 of life, weighing 2774 g, on oral feeding, without significant complications.
This case emphasizes how prematurity significantly affected the patient's clinical outcomes, and highlights the importance of individualized management strategies. Our experience demonstrates that custom silo placement allows for the size to be adapted to the abdominal defect, and highlights the critical need to prioritize postnatal bowel perfusion in ELBW infants with gastroschisis.
腹裂是一种罕见的先天性异常，腹部器官通过腹壁缺损疝出。由于极低出生体重（ELBW）婴儿生理不成熟且并发症风险增加，管理此类婴儿的腹裂存在重大挑战。
本报告讨论了一名ELBW女婴的病例，该婴儿在孕29周时通过急诊剖宫产出生，体重768克，产前诊断为腹裂。产后管理包括立即进行手术干预，使用由膨体聚四氟乙烯（ePTFE）片材手工制作的袋子，将其缝合到患者腹壁以适应其小腹腔并保留肠系膜血流。出现了坏死性小肠结肠炎伴肠穿孔的并发症，导致切除10厘米的回肠段并进行回肠造口术。该婴儿体重增加不足且出现肝功能障碍。然而，她最终在出生后第142天出院，体重2774克，经口喂养，无明显并发症。
该病例强调了早产如何显著影响患者的临床结局，并突出了个体化管理策略的重要性。我们的经验表明，定制袋子的放置可使其尺寸适应腹部缺损，并突出了在患有腹裂的ELBW婴儿中优先考虑产后肠道灌注的迫切需求。
