Complicated Gastroschisis with Progressive Fetal Bowel Dilatation: A Case Report

Background: Gastroschisis is a congenital abdominal wall defect associated with significant morbidity and mortality, particularly when complicated by severe intestinal inflammation or ischemia. Case Presentation: We report the case of a 27-year-old primigravida with fetal gastroschisis diagnosed at 18 weeks’ gestation. Serial prenatal ultrasonography demonstrated progressive bowel wall thickening and marked dilatation of the eviscerated bowel, increasing from 1.9 cm at 33 weeks to 2.53 cm at 35 weeks, suggestive of severe intrauterine intestinal injury. Following antenatal corticosteroid administration, a male neonate was delivered at term. At birth, the bowel appeared markedly edematous, congested, and ischemic. Surgical management on day of life one consisted of bowel reduction and primary fascial closure. The postoperative course was complicated by rapid hemodynamic deterioration consistent with systemic inflammatory response syndrome and abdominal compartment syndrome, refractory to maximal supportive therapy. The neonate died on day three of life due to multi-organ failure. Conclusion: This case underscores the prognostic value of serial prenatal ultrasound in identifying severe intestinal compromise in gastroschisis. In fetuses demonstrating marked bowel dilatation and wall thickening, the findings support consideration of staged reduction strategies over primary closure to mitigate the risk of postoperative systemic inflammatory response syndrome and abdominal compartment syndrome.