Iatrogenic Abdominal Wall Defect from Chronic Evisceration of Intestine: A Complication of Fetal Vesico–amniotic Shunt Dayang Anita Abdul Aziz 1* , Marjmin Osman 1 , SyarizIzry Sehat 1 , Rohana Jaafar 2 and Zarina Abdul Latiff 2 1 Paediatric Surgery Unit, Department of Surgery, UKM Medical Centre, Malaysia 2 Department of Pediatrics, UKM Medical Centre, Malaysia * Corresponding author: Dr. Dayang A Aziz, Associate Professor, Head of Pediatric Surgery UKM Medical Centre, Department of Surgery, Level 8, UKM Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia, Tel: +6012 3059439; Fax: +603 91456648; E-mail: dayanganita@yahoo.co.uk Received Date: 3 February, 2014, Accepted Date: 24 February, 2014, Published Date: 28 February, 2014 Copyright: © 2014 Dayang A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. Abstract Vesico-amniotic shunt is one of the methods used to relieve fetal bladder obstruction in some cases of lower urinary tract obstruction. We highlight a 35 week gestation baby boy, who developed acquired abdominal wall defect following placement of the antenatal vesico-amniotic shunt. It is one of the rare complications of placement of vesico- amniotic shunt. Keywords Fetal; Lower urinary tract obstruction; Abdominal wall defect Introduction Lower Urinary Tract Obstruction (LUTO) in fetus if left undiagnosed can lead to grave complications in newborn. With recent advancement in fetal management, LUTO can now be diagnosed antenatally. Creation of vesico-amniotic shunt is one of the treatments of choice. This procedure is not without complications. Case Report We highlight a male baby, born at 35 weeks of gestation via emergency LSCS who developed an unusual complication from a chronic dislodgement of catheter used for vesico-amniotic shunt procedure. Antenatally, at 19 weeks of gestation, the mother was noted to have oligohydromnios. Detail antenatal scan confirmed the finding and revealed that the fetus also had a left multicystic kidney and bilateral hydronephrosis. LUTO was diagnosed in the fetus and decision was made for fetal intervention; a vesico-amniotic shunt was performed at 22 weeks of gestation. The shunt-catheter was noted to dislodge from the fetal bladder at 31 week of gestation. The oligohydromnios recurred and the pregnancy was terminated at 35 weeks. At birth the baby required immediate ventilation with high setting. He was not dysmorphic. There was a noticeable 2×2 cm round defect at the abdomen, above and to the left of the umbilicus. Small bowel eviscerated through the defect together with the shunt catheter (Figure 1-3). The bowels were twisted and dusky. He was also diagnosed with possible urethral hypoplasia after episode of anuria. Only a tip of the urinary catheter was able to admit into the urethra. Urgent bedside surgical repair was performed and intraoperatively, a band was noted across the bowel causing narrowing of the bowel. The bowel was also twisted at the axis. The bowel improved in color after released of the band and untwisting of the bowel. The abdominal defect was closed in layers and suprapubic catheter inserted. Despite the surgical intervention, the baby succumbed to the complication of pulmonary hypoplasia at day 3 of life. Figure 1: Matted and dusky bowel with visible vesicoamniotic catheter. Figure 2: Arrow showing a band across the bowel where the volvulus occurred. Case Report Open Access Journal of Surgery [Jurnalul de Chirurgie] ISSN:1584-9341 JOS, an open access Volume 10 • Issue 1 • 14 Journal of Surgery [Jurnalul de Chirurgie] J o u r n a l o f S u r g e r y [ J u r n a l u l d e C h i r u r g i e ] ISSN: 1584-9341