A Rare Left-Sided Abdominal Wall Defect

Abstract

A 4-hour-old boy is presented here, who was born with a large abdominal wall defect situated in the left flank. Silo closure was necessary due to the large size of the defect. A Medline search up to December 2002 revealed only 2 other left-sided abdominal wall defects distant from the umbilicus. The possible embryology of this anomaly is discussed.

Development of gastroschisis: Review of hypotheses, a novel hypothesis, and implications for research

“…In another scenario, the primary intestinal loop may herniate normally into the umbilical cord, with another part of the gut tube herniating through an unclosed portion of the body wall. The more lateral ventral wall defects [Melikoğlu et al, 1998; Fraser and Crabbe, 2002; Carrera et al, 2003; Ameh et al, 2004] that are not adjacent to the umbilical cord have been proposed to be due to an abnormality in the migration of the lateral plate mesoderm (specifically the parietal layer). These lateral ventral wall defects allow the internal organs to either bulge, covered by a thin membrane or normal skin, or eviscerate.…”

“…Clinically, some gastroschisis defects appear some distance lateral to an intact umbilical region and several investigators have documented the presence of a skin bridge between the umbilical cord and the herniated bowel [Bernstein, 1940; Moore and Stokes, 1953; Simpson and Caylor, 1958; Thomas and Atwell, 1976; Ashburn et al, 2002; Ameh et al, 2004]. Although the origin of a skin bridge is not clear, it may result simply from growth of ectodermal tissue between the defect and umbilicus.…”

Left-sided Gastroschisis: Is it the Same Pathology as on the Right-Side?

“…In case one, the origin of the defect could be secondary to the amniocentesis, whilst in the second it could be due to abnormal abdominal pressure. Of the twenty cases of left-sided gastroschisis described in the literature, many diff er quite considerably from the classic right-sided form [2,9,13,15,19,22] , i. e. the defect is distant from the umbilicus, in the fl ank or the hypochondrium and most of the time the defect is large. The defects bear a greater resemblance to certain forms of aplasia of the fl ank [3] than to true gastroschisis.…”

Left-Sided Gastroschisis

“…The presence of left-sided gastroschisis has been rarely reported in the literature (Table 1). [1][2][3][4][5][6][7][8][9][10] Although the number of patients described total 14, not all of those described may be truly left gastroschisis. Four of these case reports describe infants with leftsided abdominal wall defects but are located away from the periumbilical region: 2 in the left hypochondrium (large skin bridges between the umbilicus and the defect) and one of each located in the left upper quadrant and left flank.…”

“…To our knowledge, only 14 other infants have been described in the literature as having left-sided abdominal wall defects. [1][2][3][4][5][6][7][8][9][10] We describe a recent case and review the literature.…”