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Very rarely, the abdominal wall will close partially or completely around the
intestines while the baby is still in the womb. This is very dangerous as it can
cause a significant amount of bowel to be lost, and can be life-altering or even
fatal.This is called vanishing or closing gastroschisis.
No genetic mutations are known to cause an abdominal wall defect. Multiple genetic
and environmental factors likely influence the development of this disorder.
Omphalocele and gastroschisis are caused by different errors in fetal development.
Is gastroschisis a genetic disorder?
No genetic mutations are known to cause an abdominal wall defect. Multiple genetic and
environmental factors likely influence the development of this disorder. Omphalocele and
gastroschisis are caused by different errors in fetal development.
Why does gastroschisis occur?
Gastroschisis is a birth defect of the abdominal (belly) wall. ... Gastroschisis occurs early
during pregnancy when the muscles that make up the baby's abdominal wall do not form
correctly. A hole occurs which allows the intestines and other organs to extend outside of the
body, usually to the right side of belly button.
When can you see gastroschisis on ultrasound?
Gastroschisis usually is detected in the second trimester using antenatal sonography. The
diagnosis can often be made by using antenatal sonography before 20 weeks' gestation. With
transvaginal sonograms, the diagnosis has been made as early as 12 weeks' gestation.
What is a silo bag?
During the fourth week of human embryonic development, the lateral body wall folds
of the embryo meet at the midline and fuse together to form the anterior body wall.
However, in gastroschisis and other anterior body wall defects, this fails to occur by
either one or both of the lateral body wall folds not moving properly to meet with the
other and fusing together.
This incomplete fusion results in a defect that allows abdominal organs to protrude
through the abdominal wall, and the intestines typically herniate through the rectus
abdominis muscle, lying to the right of the umbilicus.
At least six hypotheses have been proposed for the pathophysiology:
Distinguished from other ventral body wall defects such as omphalocele, there is no
overlying sac or peritoneum, and the defect is usually much smaller in gastroschisis.
Treatment
Gastroschisis requires surgical treatment to return the exposed intestines to the abdominal cavity and close
the hole in the abdomen. Sometimes this is done immediately but more often the exposed organs are
covered with sterile drapings, and only later is the surgery done. Affected newborns frequently require
more than one surgery, as only about 10% of cases can be closed in a single surgery.
Given the urgent need for surgery after birth, it is recommended that delivery occur at a facility equipped
for caring for these high-risk neonates, as transfers to other facilities may increase risk of adverse
outcomes.
Prognosis
If left untreated, gastroschisis is fatal to the infant; however, in adequate settings the
survival rate for treated infants is 90%.
Most risks of gastroschisis are related to decreased bowel function. Sometimes blood
flow to the exposed organs is impaired or there may be less than the normal amount of
intestine.
This may put infants at risk for other dangerous conditions such as necrotizing
enterocolitis. Also, because their intestines are exposed, infants with gastroschisis are at
increased risk for infection, and must be closely monitored.