Gastroschisis: Characteristics and Complications
Gastroschisis is characterized by prolonged postoperative ileus following surgical repair, and is not typically associated with other anomalies or chromosomal disorders. 1
Definition and Key Features
- Gastroschisis is a congenital abdominal wall defect where intestines and sometimes other abdominal contents herniate through an opening in the abdominal wall, typically located to the right side of a normally inserted umbilical cord 1
- Unlike omphalocele, gastroschisis has no membrane covering the herniated abdominal contents, which is a key distinguishing feature 2, 1
- The prevalence has been increasing worldwide from approximately 0.1 per 10,000 births in the 1970s to over 5 per 10,000 in the early 2000s 1
Associated Conditions and Anomalies
- Gastroschisis is rarely associated with chromosomal abnormalities or other non-bowel defects, making it distinct from omphalocele 1, 3
- Omphalocele, in contrast, is frequently associated with other structural anomalies (39.4% have cardiovascular defects) and chromosomal abnormalities (15.5% have conditions such as trisomies 13,18, and 21) 2
- Gastroschisis is located to the right of the umbilical cord insertion, not on the left 1
Complications and Postoperative Course
- Prolonged postoperative ileus is a hallmark complication following gastroschisis repair 1
- Neonatal morbidity depends on significant complicating factors such as bowel atresia, necrosis, and the prolonged ileus 1
- Complex gastroschisis (complicated by intestinal atresia, stenosis, perforation, volvulus and/or necrosis) requires multiple surgeries and has higher morbidity and mortality than simple gastroschisis 4
- Fetuses with gastroschisis are more likely to be born premature and with intrauterine growth restriction (IUGR), with approximately 48% of affected fetuses showing growth retardation 5
Management and Outcomes
- Gastroschisis requires early surgical intervention after birth, often followed by prolonged neonatal care 1
- Despite the challenging neonatal course, advances in surgical and post-operative care have improved survival rates to approximately 90% 1, 3
- Elective delivery at 37 weeks' gestation in a tertiary pediatric center is recommended based on compelling evidence 3
- Cesarean section should be reserved for routine obstetrical indications rather than being performed solely due to the presence of gastroschisis 3
Risk Factors
- Young maternal age is strongly associated with gastroschisis 1, 6
- Other potential risk factors include maternal smoking and recreational drug use 1, 6
- The etiology remains unknown, though both genetic and non-genetic factors appear to play roles in its development 6
In conclusion, gastroschisis is a congenital abdominal wall defect that is not typically associated with other anomalies or chromosomal disorders, is located to the right of the umbilical cord, and is characterized by prolonged postoperative ileus following surgical repair.