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Gastroschisis

Gastroschisis is a birth defect in which an infant's intestines are outside of the body because of a hole in the abdominal wall.

Causes

Gastroschisis is a type of hernia . Hernia means rupture. Babies with this condition have a hole in the abdominal wall. The child's intestines usually stick out (protrude) through the hole.

The condition looks similar to an omphalocele . An omphalocele, however, is a birth defect in which the infant's intestine or other abdominal organs protrude through a hole in the belly button area and are covered with a membrane.

Other related birth defects are rare in patients with gastroschisis.

Symptoms

  • Lump in the abdomen
  • Intestine sticks through the abdominal wall near the umbilical cord

Exams and Tests

Physical examination of the infant is enough for the health care provider to diagnose gastroschisis. The baby will have problems with movement and absorption in the gut, because the unprotected intestine is exposed to irritating amniotic fluid.

The mother may have shown signs of too much amniotic fluid (polyhydramnios ). A prenatal ultrasound often identifies the gastroschisis.

Treatment

If gastroschisis is found before birth, the mother will need special monitoring to make sure her unborn baby remains healthy. Plans should be made for careful delivery and immediate management of the problem after birth.

Treatment for gastroschisis is surgery to repair the defect . A surgeon will put the bowel back into the abdomen and close the defect, if possible. If the abdominal cavity is too small, a mesh sack is stitched around the borders of the defect and the edges of the defect are pulled up. The sack is referred to as a silo. With growth, the herniated intestine returns into the abdominal cavity and the defect can be closed.

Other treatments for the baby include nutrients by IV and antibiotics to prevent infection. The baby's temperature must be carefully controlled, because the exposed intestine allows a lot of body heat to escape.

Outlook (Prognosis)

The child has a good chance of recovering if the abdominal cavity is large enough. A very small abdominal cavity may result in complications that require additional surgery.

Possible Complications

The misplaced abdominal contents can make it difficult for the baby to expand the lungs, leading to breathing problems.

Another complication is bowel death. This occurs when intestinal tissue dies due to low blood flow or infection.

When to Contact a Medical Professional

This condition is apparent at birth and will be detected in the hospital at delivery. It may also be detected on routine fetal ultrasound exams during pregnancy. If you have given birth at home and your baby appears to have this defect, call the local emergency number (such as 911) right away.

References

Chung DH. Pediatric surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery.19th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 67.

Ledbetter DJ. Gastroschisis and omphalocele. Surg Clin N Am. 2006;86:249-260.

Updated: 10/29/2013

Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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