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GASTROSCHISIS
Introduction
Gastroschisis is a defect in the abdominal wall that usually
is to the right of a normal insertion of the umbilical cord.
There is no membrane or sac and no liver or spleen outside
the abdomen.
Gastroschisis is associated with no anomalies except
intestinal atresia.
The herniation is thought to occur as a rupture through an
ischemic portion of the abdominal wall.
It is probably produced by rupture of an embryonic
omphalocele sac in utero.
The remnants of the amnion are usually reabsorbed.
The skin may continue to grow over the remnants of the
amnion, and there may be a bridge of skin between the defect
and the cord.
The small and large bowel herniate through the abdominal
wall defect.
Having been bathed in the amnionic fluid, and with
compression of the blood supply at the abdominal defect, the
bowel wall has a very thick, shaggy membrane covering it.
The loops of intestine are usually matted together, and the
intestine appears to be abnormally short.
The membrane thickens during delay in surgical closure and
compromises the outcome
Complications
Since the bowel has not been contained intra-abdominally,
the abdominal cavity fails to enlarge, and it frequently cannot
accommodate the protuberant bowel.
Over 70% of the infants are premature, but associated
anomalies occur in less than 10% of cases.
Nonrotation of the midgut is present.
Intestinal atresia occurs frequently, because segments of
intestine that have herniated through the defect become
infarcted in utero.