Gastroschisis is the herniation of the intestines through an opening in the abdominal wall. It is a congenital defect that can be detected prenatally using imaging technologies, mainly ultrasonography. In most cases, the surgical intervention is performed on the first day after birth. In complicated cases, the repair is done in stages using a pouch (a silo) to contain extruded bowels, and wall closure is achieved over one or two weeks.
There are several types of congenital abdominal wall defects that result in the extrusion of bowels and other organs, with gastroschisis being the most frequent. Gastroschisis and omphalocele are both examples of an abnormal opening in the abdominal wall that results in the bowels protruding out of the abdomen into the amniotic sac, but they are different, well-defined conditions. Omphalocele is associated with chromosomal aberrations and malformations in several other organs; in this condition, a membrane surrounds the externalized intestines. Gastroschisis does not tend to be associated with chromosomal abnormalities or problems with other organs, and there is no membranous covering on the extruded bowels.
Gastroschisis is a relatively common congenital defect affecting about 1 in 2000 births . There has been a recent increase in its prevalence. The opening in the abdominal wall is mainly to the right of the umbilical cord. The herniated organ is most often the small bowel, which is not rotated. The bowels are exposed to the amniotic fluid, which may lead to a decrease in its functional capacity. Exposure to the amniotic fluid also results in increased levels of maternal alpha-fetoprotein, the detection of which may lead to the discovery of gastroschisis. Other clues for gastroschisis are fetal growth retardation and polyhydramnios . Gastroschisis may also be discovered by chance during a second-trimester sonography. Fetal abdominal circumference is low in gastroschisis, making the assessment of the age of the fetus difficult . Very low abdominal circumference and an abnormal gastric bubble are among the indicators for increased perinatal death or serious bowel injuries such as necrotizing enterocolitis . In one study, babies with gastroschisis delivered between 35 and 37 gestational weeks were found to have the fewest perinatal complications .
After returning home, call your provider if your baby develops any of these symptoms: Decreased bowel movements Feeding problems Fever Green or yellowish green vomit Swollen belly area Vomiting (different than normal baby spit-up) Worrisome behavioral [keckmedicine.adam.com]
For any other child, vomiting and fever would normally mean a bug, for our children it could mean intussusception, volvulus, or obstruction. Things most doctors rarely see. Simply put, gastroschisis means there are no road maps. [nicuawareness.org]
After returning home, call your health care provider if your baby develops any of these symptoms: Decreased bowel movements Feeding problems Fever Green or yellowish green vomit Swollen belly area Vomiting (different than normal baby spit-up) Worrisome [nlm.nih.gov]
If your baby has a bilious vomit or a distended abdomen medical advice should be sought. [uhs.nhs.uk]
A tube is used to drain away bile from the stomach and reduce the risk of vomiting during surgery. [news-medical.net]
- Abdominal Distension
We report here on a newborn infant who initially presented with a history of gastroschisis, abdominal distension, and jaundice. Further studies revealed that the child had findings consistent with extrahepatic biliary atresia (EHBA). [ncbi.nlm.nih.gov]
Neurodevelopment was not delayed. [ 25 ] One study found that the readmission rate of gastroschisis patients after initial discharge was 40%. 65% of readmissions occurred in the first year, the main indications being abdominal distension/pain and bowel [patient.info]
†Defined as ‘suspected enterocolitis with at least one of bilious aspirates or emesis, abdominal distension or occult or gross blood in stool (no fissure), and at least one of pneumatosis intestinalis, hepatobiliary gas, pneumoperitoneum’. [fn.bmj.com]
Zofran, also known as ondansetron, is an anti-nausea medication approved for cancer patients and people undergoing surgery who experience the side effects of nausea and vomiting. [zofranlawsuitguide.com]
Sixty-nine (40.6%) had at least one prolapsed organ besides bowel. The most commonly prolapsed organs were stomach (n 45, 26.3%), reproductive organs (n 34, 19.9%), and bladder (n 15, 8.8%). [ncbi.nlm.nih.gov]
In contrast, an exomphalos will be covered by a membrane, lies in the midline and may involve solid organ prolapse. [intechopen.com]
The most important imaging tool for the diagnosis of gastroschisis is antenatal ultrasonography, which is the cornerstone of imaging in pregnancy because it is noninvasive and not associated with exposure to radiation. Radiography is only used in the postnatal period and, for the same reason, the application of computerized tomography (CT) is inappropriate antenatally.
Ultrasonography allows for the detection of the location and features of the abdominal faults and differentiates amongst the different types of abdominal anomalies . In the case of gastroschisis, the herniated bowels have no membranous covering; thus, the image shows free-floating bowel loops with irregular shapes. Although the small bowel is most frequently extruded, other organs may also be found floating in the amniotic fluid, such as the large intestines, stomach, urinary bladder, uterus, fallopian tubes, and testes. The extruded intestines may be inflamed and swollen.
Various studies have examined the value of fetal intestinal and other features detected by ultrasonography in predicting later complications. In addition to the signs mentioned above in connection with adverse outcomes, several other characteristics have been studied as predictors of complications. Intra-abdominal bowel dilatation and polyhydramnios were both associated with bowel atresia . The predictive value of extra-abdominal dilatation is questionable: although one recent study found a significant association between extra-abdominal bowel dilatation and morbidity, a large percentage of patients with this type of anomaly were free from complications . Magnetic resonance imaging (MRI) is used mainly in complicated cases or where ultrasound results are equivocal.
- Eggink BH, Richardson CJ, Malloy MH, Angel CA. Outcome of gastroschisis: a 20-year case review of infants with gastroschisis born in Galveston, Texas. J Pediatr Surg. 2006;41(6):1103-1108.
- Siemer J, Hilbert A, Hart N, et al. Specific weight formula for fetuses with abdominal wall defects. Ultrasound Obstet Gynecol. 2008;31(4):397-400.
- Sinkey RG, Habli MA, South AP, et al. Sonographic markers associated with adverse neonatal outcomes among fetuses with gastroschisis: an 11-year, single-center review. 2016;214(2):275.e1-275.e7.
- Mesas Burgos C, Svenningsson A, Vejde JH, Granholm T, Conner P. Outcomes in infants with prenatally diagnosed gastroschisis and planned preterm delivery. Pediatr Surg Int. 2015;31(11):1047-1053.
- Fogata ML, Collins HB 2nd, Wagner CW, Angtuaco TL. Prenatal diagnosis of complicated abdominal wall defects. Curr Probl Diagn Radiol. 1999;28(4):101-128.
- D'Antonio F, Virgone C, Rizzo G, et al. Prenatal Risk Factors and Outcomes in Gastroschisis: A Meta-Analysis. Pediatrics. 2015;136(1):e159-169.
- Robertson JA, Kimble RM, Stockton K, Sekar R. Antenatal ultrasound features in fetuses with gastroschisis and its prediction in neonatal outcome. Aust N Z J Obstet Gynaecol. 2017;57(1):52-56.