Near-total jejunoileal atresia with exteriorized cecum and gangrenous appendix associated with gastroschisis: a case report

Introduction: Gastroschisis is a congenital abdominal wall defect. The complex form, especially with extensive jejunoileal atresia, is rare and carries high morbidity. Reports of near-total atresia with a preserved colon are scarce, particularly in resource-limited settings. Case presentation: A 5-day-old male presented with bilious vomiting and failure to pass meconium. Operative findings revealed gastroschisis with an exteriorized, gangrenous cecum and appendix, near-total jejunoileal atresia (only 20 cm of proximal small bowel remaining), malrotation, and a hypoplastic colon. A primary spatulated jejuno-colic anastomosis was performed after resection of non-viable tissue. Enteral feeding began on postoperative day seven. Clinical discussion: Management of complex gastroschisis with extensive intestinal loss poses major challenges. Staged procedures or proximal diversion, while common, may prolong fluid losses and delay feeding in low-resource contexts. This case highlights that a primary, length-preserving jejuno-colic anastomosis can be a necessary and feasible surgical adaptation to establish immediate enteral continuity when intestinal length is critically limited and staged approaches are untenable. Conclusion: This case confirms that primary anastomosis can achieve early bowel function. However, the infant later died from short bowel syndrome due to the unavailability of parenteral nutrition. The outcome underscores that, while surgical strategy can be adapted, survival for complex gastroschisis remains dependent on advanced nutritional support, highlighting a critical systemic gap in low-resource neonatal care.