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Gastroschisis is a serious defect of the abdominal wall, to the right of the navel. The diameter of the defect can vary. Almost half of the affected children are significantly too small for their age.
If an open abdominal wall is detected during prenatal diagnostics, vaginal delivery is strongly discouraged. Otherwise, injury to the open lying abdominal loops and further complications may occur.
Gastroschisis – When The Abdomen Is Open
In Germany, gastroschisis is often referred to as abdominal cleft. This is a major malformation of the fetal abdominal wall, also called abdomen, in the prenatal period. As a rule, this malformation develops spontaneously.
In the fetus, the intestinal loops fall forward to the right of the navel. The diagnosis is already possible by means of fine ultrasound during prenatal diagnostics. In most cases, the organs falling out of the abdomen can be treated surgically after delivery, so the prognosis for the child is relatively favorable. Gastroschisis should not be confused with omphalocele.
Causes Of Gastroschisis
To date, the causes of this malformation have not been adequately elucidated. At the present time, there are two main hypotheses that are discussed among physicians and scientists. Firstly, it is assumed that during pregnancy parts of the intestine move from the abdomen into an umbilical cord sac.
However, as soon as this sac bursts, the malformation occurs and the affected organs float in the surrounding amniotic fluid. Another suggestion is that a malformation of the abdominal wall vessels leads to a hole within the abdominal wall, causing the affected organs to fall out accordingly.
Smoking Increases Risk Of Free Organs On The Abdomen
According to various studies, the risk of abdominal cleft increases by 50 percent if the expectant mother smokes during pregnancy. Thus, smoking may play a significant part in the development of gastroschisis.
Concomitant Symptoms Of Gastroschisis
The abdominal cleft can cause other malformations. However, these are limited exclusively to the organs in the child’s abdomen. Compared to an omphalocele, in gastroschisis mostly only the intestine is affected by concomitant malformations. In this context, intestinal atresia often develops.
This is one or more occlusions of the cavities within the marginal intestinal tract. These occlusions are frequently found in the duodenum and rectum. This means some parts of the intestine are not passable.
In addition, there is a risk of spontaneous reduction of the abdominal gap. This, in turn, leads to clamping of the organs that have fallen out, causing the organ vessels to be undersupplied and die. Loss of larger parts of the intestine is not excluded.
Treatment Options For Abdominal Cleft
Thanks to modern medicine, abdominal cleft is mostly detected during pregnancy – in the course of fine diagnostics. If this is the case, the rest of the pregnancy is monitored by specialists.
In this way, a possible spontaneous reduction of the gap and the resulting consequences should be detected as soon as possible. It must also be remembered that the organs protrude from the child’s abdomen and are constantly exposed to amniotic fluid.
Since the amniotic fluid contains more and more of the child’s secretions as the pregnancy progresses, the affected organs can suffer significant damage. To prevent corresponding damage, the birth is planned before the actual delivery date.
Doctors always have to weigh up between the maturity of the child and potential damage to the organs. Interesting: There are various birthing centers that are currently discussing amniotic fluid exchange in order to reduce possible intestinal damaging substances to a minimal amount.
Birth In Gastroschisis Mostly By Cesarean Section
Due to the high risk of injury and complications, a planned cesarean section is usually performed in connection with gastroschisis. A vaginal birth is always not recommended.
For the protection of the child, birth is only possible in a birthing center that has an attached pediatric intensive care unit and pediatric surgery.
First Surgical Intervention Within A Few Hours After Birth
In order to protect the external intestinal loops from possible infections, a first surgical intervention on the child is necessary within a few hours after birth. On the one hand, it is possible to insert all external organs into the abdomen directly during an extensive operation.
Possible accompanying malformations are also corrected immediately if they are visible at the present time. In addition, the abdominal wall is closed directly afterward. Under certain circumstances, however, it is also possible to store the exposed intestinal loops in a sterile plastic bag for the time being.
This bag is fixed to the abdominal wall of the child. In the following days, the intestinal loops themselves – due to gravity – slide into the abdominal cavity. If this procedure is successful, only the abdominal gap, with a few sutures, needs to be closed.
Surgical Procedure Often Leads To Intestinal Obstruction
If parents and physicians decide on direct surgery for gastroschisis, it is usually possible to immediately relocate all loops of intestine into the abdominal cavity with the appropriate clinical experience. The abdominal wall can be closed without the use of foreign material.
However, if the use of foreign material is necessary, for example, because the abdominal cavity itself is too small, the foreign material is removed during one or even several further operations later on. However, this often results in intestinal obstructions, which are generally considered life-threatening.
After The Operation – What Parents Should Know
As soon as the free organs are in the child’s abdomen, the child receives intensive medical care in an incubator with the regulation of heat. To relieve the stomach and intestines, the child receives a stomach tube. As a rule, there is no possibility of breastfeeding or oral feeding within the first ten days.
Accordingly, the affected children are fed via infusions. To prevent possible infections, the newborns also receive a preventive antibiotic. In addition, intensive ventilation is exclusively used during the first hours of life.
However, depending on the condition and size of the child, this ventilation can be discontinued after 24 to 72 hours, allowing the child to breathe on its own. Approximately ten days after surgery, children are gradually introduced to oral nutrition. In principle, a hospital stay of at least 21 days is to be expected.
Late Effects Of Gastroschisis
In general, various late sequelae are possible due to gastroschisis. Among others, motility disorders and disturbances of intestinal transit are to be mentioned in this context.
Another point is the possible short bowel syndrome, which can occur if parts of the intestine have to be removed due to gastroschisis. Furthermore, significant problems with constipation, as well as eating and failure to thrive have been described in some cases.
FAQs About Gastroschisis
What Is Gastroschisis?
Simply explained, gastroschisis is an open abdominal wall in which the organs fall out of the abdomen. Parts of the intestine are mainly affected.
Is Gastroschisis The Same As An Omphalocele?
No. An omphalocele is a rupture of the umbilical cord.
What Causes Gastroschisis?
The causes of the abdominal cleft have not yet been clearly explained. Different theories are discussed among medical experts.
How Common Is A Cleft Abdomen?
Approximately 1 in 3,500 to 8,500 newborns are affected by gastroschisis.
What Is The Life Expectancy Of Children With Gastroschisis?
The survival rate of affected children is approximately 90 percent. After successful correction of the malformation and in the absence of any accompanying symptoms, life expectancy is not reduced.
Is Vaginal Delivery Possible In Case Of Gastroschisis?
In general, vaginal delivery is not recommended in the presence of the abdominal cleft. Instead, a planned, preterm delivery by cesarean section is usually performed.
Abortion In Gastroschisis
Since gastroschisis is a severe malformation of the child, from a legal point of view there is always the possibility of a late abortion in an appropriate specialized clinic.