 Gastroschisis

 is a birth defect of the abdominal (belly) wall.

The baby's intestines are found outside of the
baby's body, exiting through a hole beside the
belly button.
 The hole can be small or large and sometimes
other organs, such as the stomach and liver,
can also be found outside of the baby's body.

 It develops in a baby while a woman is

pregnant. This condition occurs when an
opening forms in The baby's bowel pushes
through this hole. The bowel then develops
outside of the baby's body in the amniotic
fluid.
 Specialty : General surgery, medical genetics
Symptom : Intestines extend outside of the body through a hole next to the belly button
Complications : Feeding problems, prematurity, intrauterine growth retardation.

Usual onset : During early development

Causes : Unknown
Risk factors : Mother who smokes, drinks alcohol, or is younger than 20
Diagnostic method : Ultrasound during pregnancy, based on symptom at birth

Treatment : Early surgery

 gastroschisis fatal?

Very rarely, the abdominal wall will close partially or completely around the
intestines while the baby is still in the womb. This is very dangerous as it can
cause a significant amount of bowel to be lost, and can be life-altering or even
fatal.This is called vanishing or closing gastroschisis.

What is the survival rate for gastroschisis?

The incidence of gastroschisisis is 4-5/10000 . It can occur isolated or associated with

other congenital anomalies. The survival rate of gastroschisis cases is over 90% in the
literature due to developments in antenatal care, neonatal intensive care and total
parenteral nutrition.
 How do you treat gastroschisis?
 Treatment for gastroschisis is surgery to repair the defect. The surgeon will put the
bowel back into the abdomen and close the defect, if possible. If the abdominal
cavity is too small, a mesh sack is stitched around the borders of the defect and the
edges of the defect are pulled up. The sack is called a silo.

Is gastroschisis a genetic disorder?

 No genetic mutations are known to cause an abdominal wall defect. Multiple genetic
and environmental factors likely influence the development of this disorder.
Omphalocele and gastroschisis are caused by different errors in fetal development.
Is gastroschisis a genetic disorder?

No genetic mutations are known to cause an abdominal wall defect. Multiple genetic and
environmental factors likely influence the development of this disorder. Omphalocele and
gastroschisis are caused by different errors in fetal development.
Why does gastroschisis occur?

Gastroschisis is a birth defect of the abdominal (belly) wall. ... Gastroschisis occurs early
during pregnancy when the muscles that make up the baby's abdominal wall do not form
correctly. A hole occurs which allows the intestines and other organs to extend outside of the
body, usually to the right side of belly button.
When can you see gastroschisis on ultrasound?

Gastroschisis usually is detected in the second trimester using antenatal sonography. The
diagnosis can often be made by using antenatal sonography before 20 weeks' gestation. With
transvaginal sonograms, the diagnosis has been made as early as 12 weeks' gestation.
 What is a silo bag?

 Silo bags are preformed silicone bags that are

used for children with gastroschisis (abdominal
wall defect). Silo bags allow a postnatal
retraction of emerged stomach and intestinal
parts without surgery.
 The other end of the silo is hung above the
baby. This allows gravity to help the
intestine to slip into the belly. Each day, the
health care provider also gently tightens the
silo to push the intestine into the belly. It
may take up to 2 weeks for all of the
intestine and any other organs to be back
inside the belly.
 Pathophysiology

 During the fourth week of human embryonic development, the lateral body wall folds
of the embryo meet at the midline and fuse together to form the anterior body wall.
 However, in gastroschisis and other anterior body wall defects, this fails to occur by
either one or both of the lateral body wall folds not moving properly to meet with the
other and fusing together.
 This incomplete fusion results in a defect that allows abdominal organs to protrude
through the abdominal wall, and the intestines typically herniate through the rectus
abdominis muscle, lying to the right of the umbilicus.
At least six hypotheses have been proposed for the pathophysiology:

1.Failure of mesoderm to form in the body wall.

2.Rupture of the amnion around the umbilical ring with subsequent herniation of
bowel.
3.Abnormal involution of the right umbilical vein leading to weakening of the body
wall and gut herniation.
4.Disruption of the right vitelline (yolk sac) artery with subsequent body wall damage
and gut herniation
5.Abnormal folding of the body wall results in a ventral body wall defect through
which the gut herniates.
6.Failure to incorporate the yolk sac and related vitelline structures into the yolk sac
Diagnosis

 Gastrochisis in ultrasound: defect is right to midline

In the developed world, around 90% of cases are identified during normal ultrasound
screens, usually in the second trimester.

 Distinguished from other ventral body wall defects such as omphalocele, there is no
overlying sac or peritoneum, and the defect is usually much smaller in gastroschisis.
Treatment

Gastroschisis requires surgical treatment to return the exposed intestines to the abdominal cavity and close
the hole in the abdomen. Sometimes this is done immediately but more often the exposed organs are
covered with sterile drapings, and only later is the surgery done. Affected newborns frequently require
more than one surgery, as only about 10% of cases can be closed in a single surgery.

Given the urgent need for surgery after birth, it is recommended that delivery occur at a facility equipped
for caring for these high-risk neonates, as transfers to other facilities may increase risk of adverse
outcomes.
Prognosis

 If left untreated, gastroschisis is fatal to the infant; however, in adequate settings the
survival rate for treated infants is 90%.
 Most risks of gastroschisis are related to decreased bowel function. Sometimes blood
flow to the exposed organs is impaired or there may be less than the normal amount of
intestine.
 This may put infants at risk for other dangerous conditions such as necrotizing
enterocolitis. Also, because their intestines are exposed, infants with gastroschisis are at
increased risk for infection, and must be closely monitored.