Gastroschisis with multiple atresia and impending rupture of small intestine

We herein report an unusual case of multiple atresia and impending rupture of the small intestine in a patient with gastroschisis. Gradual bowel dilatation and thinning of the bowel wall were confirmed at our institution by fetal imaging, which led to the suspicion of intestinal atresia. The patient underwent repair of the perforation and small intestinal resection, formation of a separate stoma, and primary closure of the abdominal wall defect. The specimen from the impending rupture of the small intestine showed partial absence of the mucosal and muscular layers on the antimesenteric side and irregular thickness of the lamina and tunica muscularis, including the non-dilated intestine. The vascular density was lower in the area with absence of the mucosal and muscular layers than in the area with normal layers. We speculate that the multiple small intestinal lesions resulted from chronic vascular stress and high intestinal internal pressure. Intestinal lesions in patients with gastroschisis cannot be excluded even when dramatic bowel distention and thickening are absent on prenatal ultrasonography. In cases of prenatally diagnosed gastroschisis, cesarean delivery should be performed as soon as possible to minimize the damage caused by intestinal lesions.