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Gastroschisis

Gastroschisis is a type of abdominal wall defect in which the intestines and sometimes other organs develop outside the fetal abdomen through an opening in the abdominal wall. This results in the intestines being located outside of the abdomen, and exposed to the air. Unlike omphalocele (covered later) there is no covering or “sac” over the intestines. Gastroschisis is an abdominal wall defect located to the side of the umbilical cord (umbilicus). As a result, the stomach, small and large intestines are not enclosed in the abdominal wall and appear outside of the fetus's body, leaving the intestine exposed to amniotic fluid, which contains the baby's urine. Tibboel et al also showed that a fibrous peel surrounds the herniated bowel beginning at approximately 30 weeks' gestation. Ischemic changes in the bowel loops usually are not seen in fetuses with gastroschisis who were aborted before 30 weeks' gestation. As the fetus grows, the opening may become smaller, and may tighten around the intestine, or the bowel could twist around itself .In contrast to infants with omphalocele, associated problems are relatively rare in patients with gastroschisis. Genetic counseling and further genetic testing , such as amniocentesis , may be offered during the pregnancy as some abdominal wall defects are associated with genetic disorders. Gastroschisis is classified as an open fetal defect by virtue of the finding that it is not covered by skin. Open fetal defects allow diffusion of AFP from the fetal circulation into amniotic fluid. As such, some infants undergoing immediate closure of the gastroschisis will require placement of a “silo” in the operating room (Dacron-reinforced Silastic silo) as a temporary housing for the intestines Rarely, ectopia cordis has been recorded. Chromosomal anomalies in gastroschisis are extremely rare, and most centers do not recommend karyotyping in infants with gastroschisis. The infant is returned to the operating room for closure of the gastroschisis. Antibiotics are discontinued shortly after the silo is removed.

Gastroschisis is a congenital defect of the abdominal wall. Sonographic findings of bowel abnormalities are associated with difficult abdominal wall repair and an increased incidence of complications. Experimental animal models have shown that when bowel is exposed to allantoic contents, it thickens, becomes edematous, and develops a fibrous peel, whereas bowel exposed to amniotic fluid alone develops normally. The opening, which is usually less than two inches in size, occurs almost always to the right of the umbilical cord. The upper end of the silo is tied with umbilical tape, which is suspended loosely over the infant. An antibiotic ointment is placed around the base of the silo at the skin to prevent infection.As in omphaloceles, the abdominal cavity may be small and replacement of the bowel into the cavity may require several weeks in which the abdominal cavity is gently stretched to accommodate the mass. The lower maternal serum AFP level in open fetal defects reflects the fact that the amnion represents a significant barrier to the diffusion of AFP from the amniotic fluid into the maternal circulation .Both of these problems may lead to poor function of the bowel after delivery. This process is usually completed within 1 to 3 weeks in most cases. The infant is returned to the operating room for closure of the gastroschisis. Antibiotics are discontinued shortly after the silo is removed.

Causes of Gastroschisis

  • Factors associated with high-risk pregnancies, such as maternal illness and infection, drug use, smoking, and genetic abnormalities, can be associated with birth of babies with omphalocele and gastroschisis
  • Polyhydramnios suggests fetal intestinal atresia, and this possibility should be investigated with ultrasonography.
  • An omphalocele, however, is a herniation of the abdominal contents through the umbilical cord, and is covered with a sac -- while gastroschisis is a herniation through the abdominal wall (usually to the right of the umbilical cord), which does not involve the cord.
  • It is similar to an omphalocele in appearance.
  • Folic acid deficiency, hypoxia, and salicylates have caused laboratory rats to develop abdominal wall defects, but the clinical significance of these experiments is conjectural.

Symptoms of Gastroschisis

  • Intestine protruding through the abdominal wall near the umbilical cord (navel)
  • Gut motility and absorption affected due to the unprotected intestine being exposed to irritating amniotic fluid
  • The unprotected intestine is exposed to irritating amniotic fluid, and as a result, gut motility and absorption may be affected.
  • Fortunately, other associated congenital defects are rare in patients with gastroschisis.

Treatment of Gastroschisis

  • The baby's temperature must be carefully controlled, since the exposed intestine allows a lot of body heat to escape.
  • Temperature regulation is extremely important in these infants because the exposed intestine provides a huge surface area for heat loss
  • The use of a preformed silo initially followed by delayed fascial closure in infants with gastroschisis is associated with improved fascial closure rates, fewer ventilator days, more rapid return of bowel function, and fewer complications compared with attempts at initial early repair.
  • The bag is sterile, impermeable to micro-organisms, transparent, flexible, resistant, internally smooth, does not adhere to the bowel loops, readily available, and inexpensive, properties that make it an excellent alternative as a prosthesis for staged surgical treatment of congenital anomalies of the abdominal wall such as GS and omphalocele.

 


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