Gastroschisis

Definition
Gastroschisis is a herniation (displacement) of the intestines through a defect on one side of the umbilical cord.

Causes, incidence, and risk factors

Gastroschisis is a congenital defect of the abdominal wall. It is similar to an omphalocele in appearance. 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. In addition, in gastroschisis, the intestines (bowels) are exposed.

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.

Symptoms

• Lump in the abdomen
  
• 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

Fortunately, other associated congenital defects are rare in patients with gastroschisis.

Signs and tests
Physical examination of the infant is sufficient for the health care provider to diagnose gastroschisis. The mother may have shown signs indicating excessive amniotic fluid (polyhydramnios). Prenatal ultrasonography often identifies the gastroschisis.

Treatment

The bowel is surgically replaced in the abdomen and the defect closed if there is adequate room. If the abdominal cavity is too small, a mesh sack is sutured around the margins of the abdominal defect and the edges of the defect are pulled up. Gravity draws the herniated intestine back into the abdominal cavity, slowly stretching it to the point where the defect can be closed.

The baby is given intravenous nutrition, and antibiotics due to unavoidable contamination by the exposed gut. Temperature regulation is extremely important in these infants because the exposed intestine provides a huge surface area for heat loss.

Expectations (prognosis)
Likelihood of recovery is good if the abdominal cavity is relatively large enough. A very small abdominal cavity may result in complications requiring additional surgery.

Complications

• Respiratory distress (the misplaced abdominal contents can cause difficulty with expansion of the lungs)
  
• Bowel death (necrosis)

Calling your health care provider
This condition is apparent at birth and will be detected in the hospital at delivery. It may also be detected on routine fetal ultrasound exams. If you have given birth at home and your baby appears to have this defect, go to the emergency room or call the local emergency number (such as 911) immediately.

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