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Detailed information of GASTROSCHISIS
GASTROSCHISIS
DEFINITION:
A congenital defect of the anterior abdominal wall characterized
by the protrusion of the intestines uncovered by peritoneum.
EPIDEMIOLOGY:
- incidence: 1/10,000 - 1/12,000
PATHOGENESIS:
- an antenatal or perinatal herniation at the base of the
umbilical cord allowing variable amounts of intestine to
herniate out into the amniotic fluid
CLINICAL FEATURES:
- always left of the gastroschisis and separated by a bridge
of skin
2. Small Intestine
- +/- a portion of the liver
3. Bowel Loops
- thickened, adherent, and shortened with a confluent
gelatinous layer
- frequently infarcted or atretic
4. Abdominal Cavity
- more adequately developed than in an omphalocele
5. Covering Sac
6. Congenital Malformation
- infrequent (14%) - Jejunoileal Malformations
2. Associated Gastrointestinal Anomalies
- adhesions
- malabsorption
- Meckel's diverticulum
- protein-loosing enteropathies
- stenosis, atresia
- volvulus
3. Complications
- IUGR (77%)
- Premature (55%)
- Mortality (80% with CHD) - 40%
- Small for Gestational Age (29%)
- Associated non-Gastrointestinal anomalies (7-30%)
- Cardiac anomalies (<8)
INVESTIGATIONS:
2. Imaging Studies
- Abdominal X-Ray
- Abdmonial Ultrasound
- 2D-Echo
- (work-up for other anomalies)
MANAGEMENT:
- intubate
- ventilate and oxygenate
- fluid resuscitation
2. Temperature Control
- wrap infant in Saran wrap or a plastic drape
- warm saline bathing
3. Infection Control
- antibiotics (Ampicillin and Gentamicin)
2. Gastroschisis or Omphalocele
- carefully wrap in saline-soaked pads
- support without tension
- NG tube for intestinal decompression
- abdominal ultrasound for nature of herniated viscera
3. Search for Other Congenital Anomalies
4. Surgical Management
- see file on "Omphalocele" for details
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Pediatric Database - GASTROSCHISIS
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