Extremely rare: < 20 reported cases . Congenital anomaly characterized by evisceration of abdominal organs (part of the liver, small intestine or colon) through a defect of the chest wall. This abnormality is more common on the left side (3:1) and in girls (3:1). The cause is unknown: fusion anomaly of the transverse septum and pleuroperitoneal membrane, vascular anomaly ...

A distinction is made between:

• isolated thoracoschisis
• thoracoschisis associated with other abnormalities: malformation of a limb, more or less important diaphragmatic hernia, cardiac malformation.  It is then part of an LBWC complex (acronym for Limb Body Wall Complex).

The reduction is done by a thoracotomy (to resect or reintegrate the organs into the abdomen via the membranous sac that crosses the diaphragm and to connect them to the abdominal cavity) associated with a small laparotomy.  When the volume of eviscerated organs is large, it may be necessary to carry out their gradual reintegration using the Schuster's technique ('silo') as in case of laparoschisis.

Anesthetic implications:

preoperative echocardiography (malformation, pulmonary hypertension ?), more or less significant hypoplasia of the homolateral lung; difficulties in reintegrating eviscerated organs in the abdomen

References :

-        Eck DL, Brooke MN, Poulos ND, Joseph TJ III,  Gohalem FG, Robie DRK.
Thoracoschisis : case report and review of the literature
Annals of Pediatric Surgery 2015 ; 11 :143-6

-        McKay JD, Parker CM, Loewen J, Cundiff CA, Herman HK, Abramowsky CR, Shehata BM.
Thoracoschisis: a case report and review of literature.
Fetal and Pediatric Pathology 2015; 34:307-14.

-        Abdelkader BS, Abdelbary MAA, Ahmed AN.
Isolated thoracoschisis.
J Pediatr Surg Case Reports 2020; 60:101538

Updated: September 2021