Presentation
Newborn with open abdominal cavity, meconium aspiration and respiratory distress.
Patient Data
Portable supine chest and abdominal X-ray confirm severe surfactant deficiency disorder with likely superadded meconium aspiration pneumonitis and or congenital pneumonia. There is rotated positioning at the time of exposure. Ill-defined cardiomediastinum.
The ET tube is at the T1/T2 vertebral level and minimally infraclavicular. The nasogastric tube is at the gastro-esophageal junction. There are overlying ECG leads and a right hypochondrial temperature lead. There is a left internal jugular access Broviac line in situ.
There is a paucity of bowel gas, with a central coil and bag.
The humeral ossification centers are absent.
There are 12 pairs of ribs. The visualized thoracic and abdominal skeleton is otherwise normal.
A follow-up X-ray reveals significant respiratory improvement post hydration, ventilation and surfactant administration and ongoing antibiotic therapy, with persistent multifocal ground-glass opacity, right upper lobe consolidation/collapse, and a normal cardiomediastinal contour.
The ET tube is infraclavicular at T3/T4 vertebral level.The nasogastric tube is within the gastric fundus. There is a left internal jugular access Broviac line, with overlying ECG leads and right hypochondrial temperature lead.
Central bowel gas pattern with a ventral coil and bag.
This is an X-ray of the non deployed/unopened Bentec ventral wall defect reduction silo bag.
The open end of the silicone silo bag has a stainless steel coil for reinforcing the band to retain sutures. It is designed to be inserted through the abdominal wall defect into the peritoneal cavity and sutured around the undersurface of the entire circumference of the defect, should this be the need. Alternatively, it can provide a sutureless approach in the NICU, while planning and awaiting primary reduction and closure.
The silicone silo bags are soft, transparent, and flexible. They allow the bowel and herniated contents to be readily visualized. As the infant grows and the peritoneal cavity increases in size, the surgeon can gradually reduce the visceral contents back into the peritoneal cavity by manual manipulation assisted by gravity.
Disclosure: I, Ashesh I Ranchod, have no actual or potential ethical or financial conflict of interest in relation to this device. This case is not intended to be a personal endorsement or recommendation of this product.
Portable ultrasound revealed intra-abdominal kidneys with moderate hydronephrosis and hydroureter. (The bladder is herniated through the defect and present within the silo bag).
The infant underwent a surgical corrective procedure 24 days post-birth.
The immediate post-operative X-ray confirms a paucity of bowel gas, with a persistent central non-distended bowel gas pattern.
The ET tube is at T3/T4 vertebral level, persistent left internal jugular venous access Broviac line, nasogastric tube in situ, overlying ECG leads and epigastric temperature lead.
Persistent ground-glass opacity and parenchymal shadowing.
Postoperative ultrasound confirmed some resolution of the initially documented hydronephrosis and hydroureter.
On day 46, there is a persistent central bowel with a normalization of the gaseous pattern somewhat. The baby is passing stools.
Case Discussion
The baby was born with a right paraumbilical defect.
Herniated distal stomach, entire small and large bowel, distal ureters, bladder, uterus, bilateral ovaries including fallopian tubes were identified at birth protruding through the ventral abdominal wall defect. There was documented absence of a surrounding membrane.
A portable Ultrasound at birth revealed mild to moderate hydronephrosis and mild hydroureter, which subsequently resolved post-operative reduction.
There were no skeletal anomalies subsequently confirmed, especially no sacral anomalies or features of caudal regression and no imperforate anus.
The Bentec ventral wall defect reduction silo bag is a life-saving device that allows staged reductions for ventral wall defects such as gastroschisis and omphalocele. In cases of ventral wall defects, there is continued extra-abdominal/extracelomic growth of the herniated or eviscerated gastrointestinal tract and simultaneous underdevelopment of the abdominal cavity. This presents a serious and unique surgical challenge to manage the infant. The degree of underdevelopment of the abdominal cavity is related to the volume of externally eviscerated contents and the duration of the evisceration. The silo bag solves this problem by providing a closed environment while allowing the cavity to grow until reduction and closure can be performed.
This was the case in this instance, as the infant underwent operative reduction and closure on day 24. The silo bag protected the herniated contents for 24 days prior to surgical intervention.
Disclosure: I, Ashesh I Ranchod, have no actual or potential ethical or financial conflict of interest in relation to this device. This case is not intended to be a personal endorsement or recommendation of this product.
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