Primary closure of gastroschisis aided by ileostomy: A new management approach for low resource settings

Abstract

Background: The outcome of gastroschisis largely depends on place of birth. Prognosis is excellent with >95% survival in high income countries (HIC) while mortality remains high in low-income and middle-income countries (LMIC). Gastroschisis has nearly 100% mortality rate in our country, which has made it the most frustrating condition for pediatric surgeons. Case presentation: Recently we attempted a different approach for gastroschisis in order to improve the outcome. This entailed creating an ileostomy on the abdominal wall defect. In this paper we describe the first two neonates managed with this method in Ethiopia. The first case was a girl that presented on the 6th hour of life and the second was a boy that arrived to our hospital on the 24th hour of life. The results were encouraging as both of the children survived. This is a new treatment strategy which has not been previously reported. Conclusion: Ileostomy can aid primary closure of gastroschisis with minimal bowel resection. It also promotes early bowel function and initiation of feeding which is the most important factor for survival in these neonates. We believe this is the best management option for gastroschisis in LMIC.

Keywords

• Gastroschisis
• Silo
• Primary closure
• Global surgery
• Case report