Complex gastroschisis with severe neonatal compromise in a preterm infant: a case report

Abstract

Gastroschisis is a congenital full-thickness abdominal wall defect characterized by herniation of abdominal viscera most commonly the small intestine-through a paraumbilical defect without a protective sac. The defect typically occurs to the right of the umbilical cord insertion, resulting in direct intrauterine exposure of the bowel to amniotic fluid, which can cause inflammation, thickening, compromised motility, and significant neonatal morbidity. In contrast to omphalocele, gastroschisis is usually isolated and un-associated with chromosomal abnormalities; however, outcomes worsen in the presence of prematurity, complex bowel pathology, or additional structural anomalies. We report a case of a 36-year-old multiparous woman at 34-35 weeks of gestation presenting with uterine contractions and vaginal bleeding. Prenatal ultrasonography demonstrated an anterior abdominal wall defect with eviscerated bowel loops floating freely within the amniotic cavity, consistent with gastroschisis, along with fetal hydrothorax suggesting severe intrauterine compromise. A premature neonate was delivered via cesarean section with a birth weight of 1670 g and severely depressed Apgar scores, requiring immediate resuscitation. Postnatal findings confirmed extensive bowel exteriorization, marked physiological instability, and multiple associated congenital anomalies. This case illustrates a severe, complex presentation of gastroschisis in a preterm infant with profound neonatal compromise. Early prenatal diagnosis and coordinated perinatal management remain essential to improving outcomes in high-risk cases.