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.