What are the differences between gastroschisis and omphalocele?
The
anesthetic management of
gastroschisis and omphalocele is
very similar but their embryologic origin and associated pathology can vary
greatly. Both can be diagnosed during the first trimester of pregnancy by fetal
ultrasonography. High levels of α-fetoprotein (AFP) in the mother or in amniotic
fluid obtained at amniocentesis raise concerns about the possibility of an
abdominal wall defect.
The presence of a peritoneal covering is what
distin-guishes omphalocele from gastroschisis. Omphalocele results from a
failure of the intestinal contents to return to the abdominal cavity at about
the 10th week of gestation. It is covered with a membrane that protects the
contents and the umbilical cord is usually found near the apex. Gastroschisis
develops after the intestinal contents have returned to the abdominal cavity. A
defect in the abdominal wall is thought to develop due to a problem with the
omphalomesenteric artery and herniation of abdominal contents occurs without a
membranous covering. Gastroschisis is associated with a higher incidence of
intes-tinal atresia while omphalocele is more commonly associated with
congenital abnormalities outside the gastrointestinal tract. An early
amniocentesis is recommended in omphalo-cele due to the increased incidence of
trisomies, while a later amniocentesis may be done with gastroschisis to
establish lung maturity. Some believe that if the lungs are mature, an early
cesarean section should be done to decrease the changes that occur in the bowel
that is extruded in gastroschisis.
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