Left Gastroschisis Complicated by Dissociation at Gastro-Oesophageal Junction: A Rare Finding

Abstract

Case Report A 1-day-old neonate with birth weight 1.4kg, born at 36 weeks of gestation, presented to us with left gastroschisis. At presentation, baby was dehydrated and had matted bowel protruding from left abdominal wall defect (Figure 1). After initial resuscitation, baby was taken for emergency operation. She had multiple attempts for difficult intubation. On extending defect of gastroschisis in midline, it revealed nasogastric tube was in peritoneal cavity and there was total dissociation of stomach and oesophagus at gastro-oesophageal junction (GEJ) (Figure 2). There was no other perforation or atresia noted in bowel after warm saline wash and wrapping of matted bowel in warm saline soaked mops. A full thickness primary anastomosis was contemplated, and ventral hernia was created with skin cover as closure of rectus muscles lead to high abdominal pressure (18mmHg). Baby was shifted to neonatal intensive care unit (NICU) and was weaned off ventilator support after two days. The post-operative period was stormy in view of Acinetobacter sepsis and prolonged naos-gastric aspirates. We were able to start slowly infusion feeds and parental nutrition was tapered. Baby was discharged from NICU at one month of age and has been in follow up for one month with present weight of 2.76kg. Abstract A 1-day-old neonate with 1.4kg birth weight, with left sided gastroschisis, complicated by complete dissociation at gastro-oesophageal junction was managed by primary anastomosis and ventral hernia creation. The patient had prolonged post-operative hospital stay in view of sepsis and delayed tolerance of parenteral feeds and doing well in follow up.