2025 Volume 61 Issue 1 Pages 61-65
The patient was a male neonate who was transferred to our hospital at 35 weeks of gestation. He was prenatally diagnosed by fetal ultrasonography as having gastroschisis due to bowel prolapse at the umbilicus into the amniotic fluid. He was born at 36 weeks of gestation, weighing 2,052 g. Postnatal observation revealed bowel prolapse from the right side of the umbilical cord, suggesting a diagnosis of gastroschisis. We conducted an emergent operation at 4 h after birth and found an omphalomesenteric fistula opening at the umbilicus with ileal exstrophy. Thus, we diagnosed this neonate as having a ruptured omphalocele with an omphalomesenteric fistula. The intestinal segment including the fistula was partially resected and anastomosed in an end-to-end manner. Despite being bloated, the intestines were returned to the abdominal cavity, and the abdominal wall was primarily closed. It is considered that ileal exstrophy through the omphalomesenteric fistula into the amniotic fluid causes fetal intestinal obstruction, leading to the subsequent rupture of the hernia sac of the omphalocele. This condition can be difficult to differentiate from prenatal gastroschisis. It is vital to understand the variation of omphalomesenteric fistula for accurate intraoperative diagnosis. We herein report this rare case with a review of the literature.
