WOFAPS 2025 8th World Congress of Pediatric Surgery

ABIRAMI KRITHIGA JAYAKUMAR

RAINBOW CHILDRENS HOSPITAL, CHENNAI, INDIA

Introduction:

Gastroschisis is a congenital abdominal wall defect typically identified antenatally, requiring prompt postnatal management involving reduction of herniated viscera and abdominal wall closure. The standard of care mandates preservation of viable bowel and delayed closure if primary reduction is not feasible. We report an unusual case of a term neonate with postnatally diagnosed gastroschisis, wherein the exteriorized mass was a non-communicating cystic lesion, ultimately managed with primary excision and closure.

Case Presentation:

A full-term male neonate, delivered vaginally without prior antenatal diagnosis, was noted at birth to have an anterior abdominal wall defect with exteriorized gut-like structure. The baby was hemodynamically stable and explored 8 hours after birth. Intraoperatively, the exposed mass exhibited gut signature and a Meckel’s-like projection, yet was non-communicating with the bowel lumen. The lesion was found to arise from the mesentery of the terminal ileum. In deviation from conventional gastroschisis repair protocols, the mass was excised entirely due to its isolated nature, followed by primary rectus sheath repair and umbilicoplasty. Enteral feeds were initiated on postoperative day one, and the neonate was discharged uneventfully by postoperative day four. Histopathological analysis revealed an aborted enteric duplication cyst with complete epithelial sloughing, entrapped keratinous debris, and chronic inflammatory response, likely secondary to prolonged amniotic exposure.

Conclusion:

This case underscores the importance of individualized surgical decision-making in neonates with anterior abdominal wall defects. Though reduction and delayed closure is the norm in gastroschisis, selected cases with non-functional, isolated cystic lesions may benefit from primary excision, enabling early recovery and obviating the need for staged procedures.