Gastroschisis
What You Need to Know
- Gastroschisis forms during pregnancy. It occurs when an infant’s abdominal organs protrude through a hole in the abdominal wall.
- During pregnancy, gastroschisis is often identified by prenatal ultrasonography.
- Surgery is needed to repair gastroschisis, and it is performed within the first several hours after birth.
What is gastroschisis?
Gastroschisis is a rare, congenital (present at birth) defect in which an infant’s intestines protrude from the body through an opening in the abdominal wall. During pregnancy, the exposed intestine of the fetus falls out into the surrounding amniotic fluid. This can lead to irritation and swelling, as well as a shortening of the intestine. As the fetus develops, there can also be reduced blood flow to the intestines, resulting in blockages or malfunction of the organ and feeding issues after birth.
What causes gastroschisis?
It is not yet known what causes gastroschisis. However, research has indicated that the risk is greater in babies with mothers age 20 or younger. Other potential factors may include alcohol or tobacco use by the mother.
Gastroschisis vs. Omphalocele
Gastroschisis is often confused with omphalocele, another birth defect in which the infant’s intestine protrudes from the belly button area. A key difference is that during omphalocele, the intestines are covered by a thin membrane. Additionally, having other associated congenital defects is more common in patients with omphalocele.
Gastroschisis Diagnosis
During pregnancy, gastroschisis is often identified by prenatal ultrasonography. The ultrasound can see the intestine within the amniotic fluid. The mother may show signs indicating excessive amniotic fluid, a condition called polyhydramnios. In instances of gastroschisis, mothers require monitoring to make sure the unborn baby remains healthy.
After diagnosis, plans are made for careful delivery and immediate surgical management of the problem after birth. The baby’s temperature must be carefully controlled, since the exposed intestine allows body heat to escape.
Surgery to Treat Gastroschisis
Surgery is performed within the first several hours after birth. The procedure involves placing the intestines back into the abdomen and closing the opening, if possible. In most cases, a breathing tube is placed into the baby’s windpipe and ventilator machine assistance is used to help with breathing during the repair and in the immediate postoperative period.
Primary repair. When the opening is closed at the initial surgical procedure, the operation is called a primary repair.
Staged repair. If the baby’s condition is unstable and/or the abdomen cannot yet hold all of the exposed organs, immediate closure of the opening is not possible and needs to be performed in stages. To start, the exposed organs are placed into a silicone plastic pouch to protect them from infection and damage. As the swelling of the abdominal organs decreases, the intestines are gently pushed back into the abdomen over three to seven days.
Surgery Recovery
Nutrients are provided intravenously for the baby’s initial feedings. The surgical opening heals about two weeks after surgery.
After surgery, babies cannot feed right away until the intestinal damage that occurred in the womb fully recovers. When the intestines are functioning, the baby will be ready for oral or nasogastric tube feeding, which will gradually increase during recovery.
The average baby born with gastroschisis needs to stay in the hospital at least four to six weeks before hospital discharge is safe.
Outlook for Children with Gastroschisis
Following discharge from the hospital, most babies go on to live normal, healthy lives and do not have long-term complications. In a small number of children with severe disease, long-term problems with feeding and digestion may persist. Although rare, some babies may lose some of the bowel, which can lead to short bowel syndrome.
