Ni Kadek Wiwik Agustini, I Wayan Dharma Artana, Made Kardana, Putu Junara Putra, Made Sukmawati, Made Darmajaya, Kadek Deddy Ariyanta
Objective: To describe clinical presentations and management on a rare case of omphalocele, exstrophy bladder or cloacal, imperforate anus, and spinal defect complex (OEIS Complex) on an aterm baby. Case: A zero day old baby present with omphalocele, exstropy of bladder, imperforate anus, ambiguous genitalia and spinal defect. He was born aterm, spontaneously, and vigorously assisted by midwifes. His birth weight was 2300 gram, length 46 cm, and head circumference 31 cm. He was the 6th child, with mother’s history of spontaneous abortion on the 1st and 2nd pregnancies, and prematurity in other siblings. The baby was still active with good vital sign. Physical examination showed the abdomen looked distended with mass consist of omphalocele and exstrophy of cloaca with leaked meconium. The patient also had atresia ani, ambiguous genitalia and spinal defect. Laboratory investigation showed normal result, the baby gram revealed an exstrophia of bladder and hemivertebrae CV Th 10,11,12. The patient was treated in NICU, fasted and given total parenteral nutrition instead. On the 8th day he underwent laparotomy, adhesiolysis, bladder closure, cecal tubularization and colostomy, had been given antibiotics, analgetic, and used stent ureter. The patology anatomy examination result from intra bladder specimen revealed unidentified spesific organ. He showed improvement and discharged after 26th days of hospitalization. Conclusion: The OEIS complex can be diagnosed based on the clinical manifestation of omphalocele, exstrophy bladder or cloacal, imperforate anus and spinal defect. Fetal ultrasound and fetal MRI on 2nd trimester of pregnancy are critical diagnostic tool. In addition, fetal tomographic ultrasound imaging (TUI) can also be used. The prognosis of OEIS complex depends on the severity of the anomalies, which can be life threatening, in part, due to the prevalence of infection and bowel anomalies.