No abstract

Background Prenatal penetrating gunshot trauma represents a challenging scenario for healthcare providers. Trauma is the leading non-obstetric cause of morbidity and mortality during pregnancy, and even though rare, firearm injuries have the most fatal outcomes and higher fetus mortality rates. Understanding the mechanism of injury in order to identify the possible injuries and adequate management is essential. In this paper, we discuss the case of a newborn with prenatal gunshot trauma, the treatment used, and the outcome of conservative and minimally invasive management. Case presentation We present the case of a male newborn, 37 weeks of gestational age and weighing 3050 g, delivered through an emergency cesarean section with prenatal gunshot trauma. Two skin wounds were found, one in the arm and another in the left thoracic region. The patient presented with respiratory distress, bilateral pneumothorax, and pneumoperitoneum, requiring high-frequency mechanical ventilation and the placement of bilateral thoracic drains. The pneumoperitoneum was attributed to pulmonary barotrauma, with no suspicion of abdominal hollow viscera lesion. A right thoracoscopy was performed after 24 h of conservative management for the removal of the foreign body. Both the mother and the baby had a positive outcome, with no further treatment needed. Conclusions For the improvement in the result of trauma events, an adequate intervention and coordinated efforts from multidisciplinary clinical and surgical teams are required. For gunshot wounds, entry, trajectory, the final position of the bullet, and pathological findings in images need to be analyzed before taking the patient to the operative room. Chosen with strict selection criteria, some patients could benefit from conservative management.

No abstract

Primary defect closure is the surgical treatment of choice in gastroschisis. When this is not feasible, a silo is required to progressively reduce the organs and perform a deferred closure of the wall.We present the case of a newborn with gastroschisis that required the use of a silo. Once the silo had been created, the distance between borders did not allow the defect to be closed, so decision was made to conduct releasing aponeurotic incisions for mobilization purposes.Progression was uneventful, and enteral nutrition was initiated at 24 days of life. Total enteral total nutrition was achieved at 40 days of life. He received parenteral nutrition for 36 days. He was discharged at 59 days of life.Abdominal wall treatment through releasing incisions allows prostheses to be avoided and represents an alternative for these patients.