Diagnosis

Gastroschisis

Etiology

Cause [nv4]

• Defective development of mesenchyme when the body stalk joins the abdominal wall

• Elevated intra-abdominal pressure may disrupt the dysplastic abdominal wall

Pathophysiology [nv4]

1. The exposed organs are susceptible to damage from direct contact with amniotic fluid

2. May triggering immune responses and inflammatory reactions

3. Impaired intestinal function

4. External pressure on the protruding organs may cause injury and impaired peristalsis

Risk factors [nv4]

• Younger maternal age

• Maternal use of alcohol or tobacco during pregnancy

Complications [nv4]

• Atresia

• Necrosis

• Perforation

• Volvulus

• Intestinal malformations

• Short bowel syndrome

• Need for total parenteral nutrition

• Sepsis

• Necrotizing enterocolitis

• Respiratory failure

• Infection

• Feeding problems

• Intrauterine growth restriction

Epidemiology

Incidence per 100.000 [osk][vqy][zsn]

Approach

• Blood test: Maternal serum alpha-fetoprotein

• Antenatal ultrasound --> necessitating delivery in suitable hospital with neonatal intensive care unit, and a pediatric surgeon

• Blood gas analysis: hypoperfusion and/or inadequate ventilation

Treatment

1. If the stomach is distended (aerophagia) --> decompress with an orogastric tube [nv4]

2. Decompress the sigmoid colon and rectum --> facilitate reduction

3. Minimize loss of heat/moisture and protects the mesentery from twisting or stretching:

   • Cover the intestines with a moist nonadherent, semi-permeable membrane (plastic wrap)

   • Place baby in an incubator or a bowel bag

4. Hydration: 20 mL/kg lactated Ringer solution + 5% dextrose

   • Urine output provides the most accurate measure of the adequacy of fluid resuscitation

5. Broad-spectrum antibiotics

6. Reduction and closure: If the appearance of the intestines is normal

7. If the intestines are inflamed --> the intestines are placed within a silo and reduction is accomplished over the subsequent 7-10 days

Differential diagnoses

Bladder exstrophy, Omphalocele, Umbillical hernia