Gastroschisis

Question 1

Incidence

Answer 1

1:2000 live births Antenatal diagnosis common Increases with younger maternal age and associated with IUGR M:F = 1:1

Question 2

Definition

Answer 2

Gastroschisis represents a herniation of abdominal contents through a paramedian full-thickness abdominal fusion defect.
The abdominal herniation is usually to the right of the umbilical cord.
No genetic association exists.
A gastroschisis usually contains small bowel and has no surrounding membrane.
The herniated bowel is not rotated and is devoid of secondary fixation to the posterior abdominal wall.

Question 3

Pathophysiology

Answer 3

🌚Defect of abdominal wall, with free extrusion of intestine into amniotic cavity
🌚 No specific environmental factor identified

Question 4

Clinical picture

Answer 4

🤨10% with intestinal atresia Some cases associated with short bowel syndrome due to antenatal volvulus and necrosis of herniated bowel
😟 Hollow viscera (stomach, small and large bowels)
🧐Defect lateral to cord (usually right)
😏Bowel may be inflamed, thickened, matted, foreshortened Defect size variable

Question 5

Investigation

Answer 5

Prenatal U/S Elevated MS-AFP

Question 6

TX

Answer 6

🤬NGT decompression
🤬IV fluids IV antibiotics
😡Keep viscera moist and protected
😡🤬😡 surgical reduction with primary abdominal closure or staged closure with silo May have
🤬 bowel dysmotility requiring motility medications

Question 7

Prognosis

Answer 7

> 90% survival rate