Difference between revisions of "Gastroschisis"
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'''<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/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. | |||
Revision as of 14:41, 12 January 2026
Definition
- 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
Diagnosis
- 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
Epidemiology/Prognosis
- 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%
Embryology/Pathophysiology
- 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.
Surgical/Medical Management
- 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.
Anesthetic Considerations
Preoperative
Intraoperative
Postoperative
Top contributors: Samip Patel