Paediatrics: Gastroschisis

Gastroschisis

The incidence of gastroschisis is 1/3000 live births, but it is increasing. Most foetuses with gastroschisis are identified on prenatal US and delivery can then be arranged in a regional neonatal surgical centre. The abnormality is immediately apparent at birth as a defect in the abdominal wall to the right of the umbilicus (Fig. 23.15). The bowel is eviscerated and not covered by a sac. As a result of contact with amniotic fluid the bowel is thickened and matted. Associated malformations are uncommon except intestinal atresias (10%).

Management

•   Immediate: cover the exposed bowel with Clingfilmâ„¢.

•   Keep the baby warm and hydrated.

•   AXR is unnecessary.

•   Surgery: the defect requires surgical closure as rapidly as possible. Often this has to be staged using a silo because the abdomen is too small to accommodate the intestine. The silo is reduced serially over a period of 1–2wks and then s closure of the defect is performed.

•   Nutrition: total parenteral nutrition may be required for many weeks because intestinal function is slow to resume after the abdominal wall is closed. However, the long-term outcome is excellent.