From the Guidelines
The most common anomaly associated with gastroschisis is intestinal atresia. Gastroschisis is a congenital abdominal wall defect that allows the intestines and sometimes other abdominal organs to protrude outside the body through a defect typically located to the right of the umbilical cord.
- Intestinal atresia occurs in approximately 10-15% of gastroschisis cases and is thought to result from vascular compromise to the exposed bowel.
- This vascular compromise happens because the intestines, when floating freely in the amniotic fluid without the protection of the abdominal wall, can become twisted or compressed, leading to ischemia and subsequent atresia. Although there have been reports of the association of certain medications with increased congenital malformations such as gastroschisis and small intestinal atresia 1, the exact cause of intestinal atresia in gastroschisis is still not fully understood. The intestinal atresia associated with gastroschisis typically affects the small bowel and can range from a simple web-like obstruction to complete discontinuity of the intestinal segment. This complication often requires additional surgical intervention beyond the primary closure of the abdominal wall defect and can significantly impact the prognosis and recovery time for affected infants. Some studies suggest that the risks of such malformations were increased by combining a decongestant with acetaminophen or salicylates 1, but the most common anomaly associated with gastroschisis remains intestinal atresia. Key points to consider include:
- Gastroschisis is a congenital abdominal wall defect
- Intestinal atresia is the most common anomaly associated with gastroschisis
- Intestinal atresia can range from a simple web-like obstruction to complete discontinuity of the intestinal segment
- The exact cause of intestinal atresia in gastroschisis is still not fully understood, but vascular compromise to the exposed bowel is thought to play a role.
From the Research
Common Anomalies Associated with Gastroschisis
- Intestinal atresia is a common anomaly associated with gastroschisis, occurring in approximately 10% to 20% of children with gastroschisis 2
- Malrotation is also associated with gastroschisis, although the frequency of this association is not as well-defined 3, 4
- Other anomalies, such as cardiac and limb defects, may also occur in conjunction with gastroschisis 4
Frequency of Intestinal Atresia in Gastroschisis
- A study of 199 babies with gastroschisis found that 25 (12.6%) had intestinal atresia 2
- Another study of 629 gastroschisis patients found that 78 (12.4%) had intestinal complications, including atresia 5
- Intestinal atresia is a significant contributor to morbidity and mortality in patients with gastroschisis 2
Management of Intestinal Atresia in Gastroschisis
- The management of intestinal atresia in gastroschisis may involve delayed primary anastomosis or early intestinal operations 6, 5
- Early intestinal operations may allow patients to receive and tolerate enteral feeding earlier, although this practice has not been universally adopted 5
- The optimal management of intestinal atresia in gastroschisis is still a topic of debate, and further research is needed to determine the best approach 2, 6, 5