Gastroschisis / Exomphalos

Question 1

Gastroschisis

Answer 1

In gastroschisis, the abdominal
contents are uncovered and exposed
to air / amniotic fluid. The defect is
usually to the right of the umbilicus.

Question 2

Risk factors

Answer 2

(young slim mothers w/ alcohol drug abuse)
maternal smoking, alcohol consumption, illicit drug use, young maternal
age, socioeconomic status, opioid prescription during pregnancy

Question 3

Diagnosis?

Answer 3

Usually 20 week anomaly scan; bowel free-floating in amniotic fluid (no earlier -
physiologic midgut herniation). Raised AFP in maternal serum

Question 4

Delivery?

Answer 4

balance prematurity / bowel exposure to amniotic fluid; vaginal delivery 37/40

Question 5

Management after birtj?

Answer 5

OG tube (decompress stomach), 
IV fluid resus, 
silo reduction over a few
days; sutureless bedside closure. 
Large defects may require staged reduction

Question 6

Complications?

Answer 6

Increased intraabdominal pressure → abdominal compartment

syndrome, NEC, infection/sepsis

Question 7

Exomphalos

Answer 7

Defect is covered in membranous sac (peritoneum, wharton’s jelly, amnion) - umbilical
vessels insert into the sac. Exomphalos major = >4.5cm OR liver involvement.
Associated with other congenital anomalies (cardiac, chromosomal).

Question 8

Riskf factors exomphalus?

Answer 8

maternal obesity, multiple births, GDM (→ fetal macrosomia)

Question 9

Management?

Answer 9

protect sac from injury, NG tube to reduce volume. Primary or staged
closure. In larger defects may need to reduce with a silo beforehand & close surgically
(avoid umbilical vessels). Really large defects - ‘paint and wait’ (topical antimicrobials →
epithelialization. Sometimes require mesh repair.

Question 10

Complications of exomphalos?

Answer 10

Reflux, FTT, chronic lung disease, adhesive obstruction

Question 11

Umbilical hernia - how common?

Answer 11

Very common - affects around 20% of children ~90% resolve spontaneously by the time the
child is 3-4 years old

Question 12

Management of umbilical herna?

Answer 12

Usually none! Simple surgical
repair (stitches / mesh if large) - limit
strenuous activities, 1 or 2 weeks off school -
can return to normal activities within a month

Question 13

Presentation of umbilical hernia?

Answer 13

painless lump in / near belly button; increases in size / bulges with increase in intra-abdominal pressure (i.e. coughing, laughing, crying)