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 2012-02-06-08 Case of the week # 319 © Fabrice Cuillier  www.TheFetus.net 


Case of the week # 319
May 24 th, 2012-June 7th, 2012.
Fabrice Cuillier, MD.1, Michel J.L.,MD.2, Harper,MD.2, Alessandri J.L,MD.3, Bertha A.4
1 Department of Gynecology, Hopital Felix Guyon, 97400 Saint-Denis, Ile de la Reunion, France.
2 Department of Pediatric surgery, Hopital Folix Guyon, 97400 Saint-Denis, Reunion, France.
3 Department of Neonatology, Hopital Felix Guyon, 97400 Saint-Denis, Ile de la Reunion, France.
4 Student, Arizona State University. University Drive and Mill Avenue Tempe, Arizona 85281.


Case report:
The final diagnosis of this case was "closed gastroschisis ".
This patient with unremarkable history was referred to us for suspected gastroschisis of her fetus . The nuchal translucency was normal and the triple test was 1:1000.
At 17 weeks, the fetus appeared structurally normal, except for the gastroschisis without polyhydramnios (Image 1-3).
At 18 weeks, ultrasound revealed abnormal ileal and jejunal dilatation (Image 4-8). There were no other dysmorphologic signs of aneuploidy. There was no sign of meconium peritonitis and congenital infection. An amniocentesis was performed (karyotype 46 XY).
Image 1-3: Gastroschisis at 17 weeks

Image 4-8: At 18 weeks,
gastroschisis and abnormal ileal and jejunal dilatation.
  

At 23 weeks, the intestinal dilatation was increased and the gastroschisis disappeared (Image 9). There was no sign of polyhydramnios at 26 weeks. At 28, 34 and 36
weeks, the intestinal dilatation also increased, without polyhydramnios. An intestinal peristalsis was present. (Image 9-15)
Image 9-15: 23-36 weeks, 
the intestinal dilatation was increased and the gastroschisis disappeared.

   

The fetus was delivered naturally at 38 weeks. The baby was of normal appearance with normal anterior abdominal wall, except left umbilical position.
Image 16-17: Post-term images
 
On the same day, the fetus was operated. Exploratory laparotomy was performed that revealed a short small bowel. The post surgical course was abnormal with lots of complications during ten month of neonatal hospitalization.
The postnatal diagnosis was " closed gastroschisis".
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