pediatrics
Gastroschisis
Introduction
Gastroschisis is protrusion of the abdominal viscera through a full-thickness abdominal wall defect, usually to the right of the umbilical cord insertion. (See also Overview of Congenital Gastrointestinal Anomalies .) The estimated incidence is 1 in 2500 live births (more common than Omphalocele , in which the abdominal viscera protrude from a midline defect at the base of the umbilicus) ( Gastroschisis can be suspected before birth by abnormally high alpha-fetoprotein levels on prenatal blood tests and can be detected by prenatal ultrasonography ( References ); when confirmed, delivery should take place at a tertiary care center. At delivery, the exposed viscera should be immediately covered with a sterile, moist, nonadherent dressing (eg, medicated petrolatum gauze that can then be covered with plastic wrap) to maintain sterility and prevent evaporation. The infant should then be given IV fluids and broad-spectrum antibiotics (eg,ampicillin,gentamicin), and a nasogastric tube should be placed. The amount of fluids needed is typically significantly higher than that needed for a normal healthy neonate (1.5 to 2 times) because of excessive fluid loss from the exposed gut. The infant is evaluated for associated anomalies before surgical repair. Primary closure is done when feasible. When a large amount of bowel is exposed, the abdominal cavity may be too small to accommodate the viscera. In this case, the viscera are covered by a pouch or silo of polymeric silicone sheeting, which is progressively reduced in size over several days as the abdominal capacity slowly increases, until all of the viscera are enclosed within the abdominal cavity. More recently, sutureless repair of gastroschisis has been done using the umbilical cord or a synthetic dressing to cover the defect. More research is required to assess the effectiveness of this approach. It often takes several weeks before gastrointestinal function recovers and oral feedings can be given; occasionally, infants have long-term problems caused by abnormal intestinal motility. 