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.
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 antibiotics due to unavoidable contamination by the exposed gut, as well as intravenous nutrition. Temperature regulation is extremely important in these infants because the exposed intestine provides a huge surface area for heat loss.
Expectations (prognosis)
Recovery is good if the abdominal cavity is relatively large enough. A very small abdominal cavity may result in complications requiring additional surgery.
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.