Gastroschisis - Revision history

Spate215 at 21:30, 15 January 2026

2026-01-15T21:30:02Z

← Older revision		Revision as of 14:30, 15 January 2026
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	** In a primary surgical approach, the bowel is carefully evaluated for evidence of atresia, necrosis, or vascular compromise before being reduced into the abdominal cavity. In some cases, the umbilical cord may be utilized as a biologic dressing to facilitate closure.		** In a primary surgical approach, the bowel is carefully evaluated for evidence of atresia, necrosis, or vascular compromise before being reduced into the abdominal cavity. In some cases, the umbilical cord may be utilized as a biologic dressing to facilitate closure.
	** In a staged approach, a silo is placed over the herniated viscera, allowing for gradual, serial reduction of the bowel into the abdominal cavity over several days prior to definitive closure.		** In a staged approach, a silo is placed over the herniated viscera, allowing for gradual, serial reduction of the bowel into the abdominal cavity over several days prior to definitive closure.
			***A one stage closure is typically ill-advised due to the risk of developing abdominal compartment syndrome.

	<u><br />'''<big>Anesthetic Considerations</big>'''</u>		<u><br />'''<big>Anesthetic Considerations</big>'''</u>

Spate215 at 02:10, 13 January 2026

2026-01-13T02:10:17Z

← Older revision		Revision as of 19:10, 12 January 2026
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	'''<big>Definition</big>'''		'''<big><u>Definition</u></big>'''

	* ~~Abdominal~~ defect that causes a portion of the intestines and other abdominal organs to herniate '''WITHOUT''' a covering membrane/peritoneal sac		* Direct abdominal defect that causes a portion of the intestines and other abdominal organs to herniate '''WITHOUT''' a covering membrane/peritoneal sac
	* Typically located on the right side of the umbilicus		* Typically located on the right side of the umbilicus
	* Approximately ~~10-20~~% of cases are ~~a conjoining abnormality~~		* Approximately 10–20% of cases are associated with additional congenital anomalies.
	** ~~Common~~ abnormalities ~~associated with Gastroschisis~~ include undescended testes, ~~Meckel's Diverticulum~~, and intestinal duplication		**Commonly reported associated abnormalities include undescended testes, Meckel’s diverticulum, and intestinal duplication.

	~~'''<big>Diagnosis</big>'''~~

	* Identified via ultrasound during prenatal screening		'''<big><u>Diagnosis</u></big>'''
	* Elevated AFP can help confirm the diagnosis ~~if there are signs on ulrasound~~		* Identified via ultrasound during prenatal screening
	** Levels of AFP tend to be ~~high~~ in Gastroschisis compared to Omphalocele		* Elevated AFP can help confirm the diagnosis
			** Levels of AFP tend to be higher in Gastroschisis compared to Omphalocele

			<u><br />'''<big>Epidemiology/Prognosis</big>'''</u>
	'''<big>Epidemiology/Prognosis</big>'''

	* Occurs in 3-4 out of 10000 births		* Occurs in 3-4 out of 10000 births
	* Outcomes are variable, but are highly dependent on the amount of organs/intestines that have herniated and the level of prenatal care		* Outcomes are variable, but are highly dependent on the amount of organs/intestines that have herniated and the prior level of prenatal care
	** Survival rates are > 90%		** Survival rates are > 90%

			<u><br />'''<big>Embryology/Pathophysiology</big>'''</u>

			*During normal embryologic development, the intestinal tract physiologically herniates into the umbilical cord at approximately the sixth week of gestation, with expected return to the abdominal cavity by around the twelfth week.
			*In gastroschisis, this process is disrupted, most commonly attributed to an ischemic insult to the developing abdominal wall, which impairs normal closure and results in persistent herniation of the abdominal contents.

			<u><br />'''<big>Surgical/Medical Management</big>'''</u>

			* Infants with gastroschisis are frequently delivered via cesarean section to minimize the risk of additional bowel injury during passage through the vaginal canal, although the mode of delivery may ultimately be individualized based on obstetric considerations.
			* The overarching treatment goal is reduction of the herniated intestinal contents into the abdominal cavity, followed by closure of the fascial and skin defects.
			* Management strategies are influenced by several factors, including the size and type of the defect, the size and gestational maturity of the infant, and the presence of associated comorbidities.
			* Immediately after delivery, the exposed bowel is typically covered with sterile saline-soaked dressings and enclosed in a clear plastic wrap or silo. This approach helps maintain moisture and normothermia while allowing continuous visual assessment of the herniated intestines.
			* Management includes either a surgical approach vs staged approach
			** In a primary surgical approach, the bowel is carefully evaluated for evidence of atresia, necrosis, or vascular compromise before being reduced into the abdominal cavity. In some cases, the umbilical cord may be utilized as a biologic dressing to facilitate closure.
			** In a staged approach, a silo is placed over the herniated viscera, allowing for gradual, serial reduction of the bowel into the abdominal cavity over several days prior to definitive closure.

	'''<big>~~Embryology/Pathophysiology~~</big>'''		<u><br />'''<big>Anesthetic Considerations</big>'''</u>

	* At approximately the 6th week gestation, the intestinal tract typically migrates out of the umbilical cavity via the umbilical cord with the expect that it will return around/by the 12th week of gestation		'''Preoperative'''
	* However, in Gastroschisis, there is thought to be an ischemic insult to the abdominal wall that prevents closure and therefore results in persistent herniation.

			* Obtain a CBC, CMP and T&S
			** Blood loss is typically unexpected however there will be lots of evaporative losses than sometimes may be best treated with blood
			** Evaluate whether there are any electrolyte issues
			* NGT placement to decompress the stomach and decrease the risk of aspiration
			* Address any other comorbidities (VACTERL) associated with the pathology

	'''~~<big>Surgical/Medical Management</big>~~'''		'''Intraoperative'''

	* ~~These babies~~ will ~~likely~~ be ~~delivered via cesearean section to reduce~~ the ~~risk~~ of ~~any additional injury~~ to the ~~bowels during~~ the ~~birthing process via~~ the ~~vaginal canal.~~		* Standard ASA Monitors
	* ~~Goal is~~ to ~~ultimately reduce the intestinal contents back into the abdomen~~ and ~~then close the fascia/skin~~		** Temperature will be particularly important given the large amount of heat loss from the open abdomen
	* ~~Treatment will depend on the size, type of defect, size of baby, and any other comorbidities~~		* Induction
	* ~~After delivery, the bowels will~~ be ~~wrapped in sterile saline dressing and wrapped in a clear plastic. The goal~~ of ~~the sterile dressing and plastic wrap is to allow the bowels to remain moist and heated, while still being able to see the herniated intestines.~~		** Position the patient in reverse trendelenberg to minimize the pressure from the abdominal contents on the lungs
	* ~~There is a surgical approach vs a staged approach~~		** RSI to minimize aspiration risk
	** In the surgical ~~approach~~, the ~~bowels will be evaluated for any signs of atresia, necrosis~~, ~~or vascular comproise and then be placed back into the abdominal cavity~~. ~~The umbilical cord can be used as a biologic dressing~~		* Lines
	** In the ~~stage approach~~, there is a ~~serial reduction of the plastic covering that will slowly push the bowels back into the abdomen~~.		** PIVs for resuscitation
			** Arterial Line
			** Central Lines for CVP monitoring and postoperative parenteral nutrition administration
			* Maintenance
			** Patient can be maintained w/ either volatile or IV anesthetics
			** Avoid N2O due to risk of bowel distension
			** Maintain paralysis to help with abdominal closure
			** When surgical team is closing the abdomen, have close discussion with surgical team as this may cause decreased diaphragmatic excursion, compression of the lungs, increased airway pressures.
			*** If at any point there are an increase in the peak inspiratory pressures > 35 or intra-abdominal pressure > 20, there should be an active discussion with the surgical team about reopening and performing a staged repair.

			'''Postoperative'''

	~~'''<big>Anesthetic Considerations</big>'''~~		* Disposition to the NICU
			* Anticipate post operative ventilation requirements
			* Continue to monitor intra-abdominal pressures
			* Early enteral feeding and TPN discontinuation can decrease length of stay and infection risk

	~~Preoperative~~

	~~Intraoperative~~		'''<big><u>Resources</u></big>'''

	~~Postoperative~~		* Gropper M, et al. ''Miller's Anesthesia.'' Chapter 77: Pediatric Anesthesia. Section: Omphalocele and Gastroschisis. 9th ed.
			* Ledbetter DJ. Gastroschisis and Omphalocele. Surg Clin North Am. 2006;86(2):249-60. PubMed

Spate215 at 22:41, 12 January 2026

2026-01-12T22:41:31Z

← Older revision		Revision as of 15:41, 12 January 2026
Line 1:		Line 1:
	'''<big>Definition</big>'''		'''<big>Definition</big>'''

			* Abdominal defect that causes a portion of the intestines and other abdominal organs to herniate '''WITHOUT''' a covering membrane/peritoneal sac
			* Typically located on the right side of the umbilicus
			* Approximately 10-20% of cases are a conjoining abnormality
			** Common abnormalities associated with Gastroschisis include undescended testes, Meckel's Diverticulum, and intestinal duplication

	'''<big>Diagnosis</big>'''		'''<big>Diagnosis</big>'''

			* Identified via ultrasound during prenatal screening
			* Elevated AFP can help confirm the diagnosis if there are signs on ulrasound
			** Levels of AFP tend to be high in Gastroschisis compared to Omphalocele

	~~'''<big>Epidemiology</big>'''~~

			'''<big>Epidemiology/Prognosis</big>'''

	'''<big>Embryology</big>'''		* Occurs in 3-4 out of 10000 births
			* Outcomes are variable, but are highly dependent on the amount of organs/intestines that have herniated and the level of prenatal care
			** Survival rates are > 90%


			'''<big>Embryology/Pathophysiology</big>'''

			* At approximately the 6th week gestation, the intestinal tract typically migrates out of the umbilical cavity via the umbilical cord with the expect that it will return around/by the 12th week of gestation
			* However, in Gastroschisis, there is thought to be an ischemic insult to the abdominal wall that prevents closure and therefore results in persistent herniation.


	'''<big>Surgical/Medical Management</big>'''		'''<big>Surgical/Medical Management</big>'''

			* These babies will likely be delivered via cesearean section to reduce the risk of any additional injury to the bowels during the birthing process via the vaginal canal.
			* Goal is to ultimately reduce the intestinal contents back into the abdomen and then close the fascia/skin
			* Treatment will depend on the size, type of defect, size of baby, and any other comorbidities
			* After delivery, the bowels will be wrapped in sterile saline dressing and wrapped in a clear plastic. The goal of the sterile dressing and plastic wrap is to allow the bowels to remain moist and heated, while still being able to see the herniated intestines.
			* There is a surgical approach vs a staged approach
			** In the surgical approach, the bowels will be evaluated for any signs of atresia, necrosis, or vascular comproise and then be placed back into the abdominal cavity. The umbilical cord can be used as a biologic dressing
			** In the stage approach, there is a serial reduction of the plastic covering that will slowly push the bowels back into the abdomen.

Spate215: Created page with "'''Definition''' '''Diagnosis''' '''Epidemiology''' '''Embryology''' '''Surgical/Medical Management''' '''Anesthetic Considerations''' Preoperative Intraoperative Postoperative"

2026-01-12T02:31:58Z

Created page with "'''<big>Definition</big>''' '''<big>Diagnosis</big>''' '''<big>Epidemiology</big>''' '''<big>Embryology</big>''' '''<big>Surgical/Medical Management</big>''' '''<big>Anesthetic Considerations</big>''' Preoperative Intraoperative Postoperative"

New page

'''<big>Definition</big>'''

'''<big>Diagnosis</big>'''

'''<big>Epidemiology</big>'''

'''<big>Embryology</big>'''

'''<big>Surgical/Medical Management</big>'''

'''<big>Anesthetic Considerations</big>'''

Preoperative

Intraoperative

Postoperative