Surgery

Gastroschisis

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Gastroschisis

  • See Also
  1. Omphalocele
  • Definition
  1. Open peri-umbilical abdominal wall defect in newborns
  • Epidemiology
  1. Overall Incidence: 1 in 10,000 births
  2. Incidence in mothers under age 20: 7 in 10,000 births
  • Risk factors
  1. Intrauterine Growth Retardation
  2. Prematurity
  3. Young mother (under age 20)
  • Pathophysiology
  1. Abdominal wall defect lateral to Umbilicus
  2. Evisceration of Small Intestine and ascending colon
  3. Bowel abnormal - matted and thickened
  • Associated Conditions (21% of cases)
  1. Intestinal Atresia
  2. Gallbladder agenesis
  3. Renal agenesis
  • Diagnosis
  1. Usually diagnosed by prenatal Obstetric Ultrasound
  • Management
  1. Stabilization
    1. Apply warm fluid-impermeable dressing over defect
      1. Avoid excessively Wet Dressings (macerates bowel)
      2. Place lower half of baby in sterile bowel bag
    2. Orogastric Tube for decompression
    3. Fluid Resuscitation (high evaporative losses)
      1. Maintenance IV fluids: D10W or 1/4NS
      2. Start with 20 cc/kg bolus over 30 minutes
      3. Fluid requirements in Gastroschisis 2.5x normal
    4. Blood Culture
    5. Broad spectrum Antibiotic coverage
      1. Ampicillin 100 mg/kg/day and
      2. Gentamicin 5 mg/kg/day
  2. Surgical repair on first day of life
  3. Parenteral Feeding
  • Complications
  1. Necrotizing Enterocolitis
  2. Bowel perforation
  • Prognosis
  1. Mortality: 10%
  • References
  1. Feldman (1998) Sleisenger Gastrointestinal, p. 1428
  2. Townsend (2001) Sabiston Surgery, Saunders, p. 1479-80
  3. Fuloria (2002) Am Fam Physician 65(2):265-70 [PubMed]