Background: Vanishing gastroschisis may occur due to spontaneous partial or complete closure of anterior abdominal wall defect around the viscera, leading to small bowel ischemia and resultant entry/exit level atresia and extremely short length of the remaining bowel. The prognosis is very poor, even after aggressive surgery, and requires prolonged total parenteral nutrition.
Case Series: We report two female neonates, one with closed and another with closing vanishing gastroschisis, associated with jejunal atresia and extreme short bowel syndrome. In both patients, the antenatal scans showed gastroschisis without the evidence of vanishing gastroschisis. In both neonates, palliative surgeries were done. Both patients died after a few days due to short bowel syndrome and sepsis.
Conclusion: When antenatally detected gastroschisis presents with closed or closing anterior abdominal wall defect, (vanishing gastroschisis), the parents/caregivers must be counseled about the poor prognosis of this condition. A tailored approach to either palliation or aggressive therapy is essential in this rare condition.
Association of posterior urethral valve with neonatal intestinal obstruction is rare; rarer still is its association with meconium ileus. A 1-day-old male presented with features of neonatal intestinal obstruction. Gastrografin enemas confirmed microcolon and were therapeutic. Later, the neonate developed overflow incontinence and deranged renal functions; micturating cystourethrogram confirmed posterior urethral valve. Cystoscopic valve fulguration was performed after stabilization; outcome was favourable.
Background: The diagnosis of perforation in the absence of pneumoperitoneum in necrotizing Enterocolitis (NEC) remains difficult. The decision to operate should be taken up during the “golden period” which occurs after the onset of intestinal gangrene, but before intestinal perforation. This study was done to analyse the outcomes of two groups of surgically managed NEC patients based on the radiographic findings (presence or absence of pneumoperitoneum) and compare the actual surgical findings.
Methods: A prospective observational study was performed from October 2018 to February 2020. The operated patients of NEC were divided into two groups based on the preoperative presence (Group A) or absence of pneumoperitoneum (Group B). A “p” value of less than 0.05 was considered significant for comparative analysis.
Results: There were 81 patients with clinico-radiological signs of NEC during the study tenure; 51 infants underwent surgery. Group A had 35 (69%) and Group B had 16 (31%) patients. In 11/16 (69%) patients of Group B, perforation was detected and 5/16 (31%) had only gangrenous and necrosis of bowel segment. Out of 16 patients (Group B), predictors of NEC like abdominal wall erythema (Modified Bell's stage IIB) were present in 4 (25%), fixed bowel loops (stage IA/IB) 3 (19%), pneumatosis intestinalis (stage IIA) 1(6%), portal venous gas (stage IIB) 1 (6%), and ascites (stage IIIA) 2 (12%) were observed. The complication rate was 77% among patients of Group A and 44% in Group B (p=0.01). Survival was greater (63% vs. 29%) among Group B patients than Group A (p=0.02).
Conclusions: The importance of not relying only on the pneumoperitoneum on radiographs; early diagnosis and prompt surgical intervention is emphasized. Surgical indication for NEC should always be based on the patient’s cumulative clinical and radiologic assessment, especially in the absence of pneumoperitoneum to improve survival rates.
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