Gastroschisis

Gastroschisis is a birth defect in which the intestines protrude through a defect on one side of the umbilical cord, according to specialists at the University Center for Fetal Medicine. It is a type of hernia and occurs predominately to the right side of the umbilical cord. Gastroschisis is similar in appearance to an omphalocele, but lacks a membrane covering the hernia contents. Associated congenital defects are rare in infants with gastroschisis.

Evaluation

Gastroschisis may be identified with routine prenatal ultrasonography or, in patients with little or no prenatal care, it may be diagnosed at birth. If gastroschisis is diagnosed before birth, the mother will be referred to a specialist for detailed ultrasonography and fetal MRI.

Gastroschisis 1

Pictured (right) is a MRI of a fetus with gastroschisis. The bowel protruding through the abdominal wall is indicated by the arrow. The bowel outside the abdomen floating in amniotic fluid is indicated by the white circle.

Once the diagnosis of gastroschisis is made, the mother and fetus will be carefully monitored throughout the remainder of pregnancy to ensure that both remain healthy.

Plans should be made to deliver at a medical center that has both a pediatric surgeon on staff and a neonatal intensive care unit (NICU).

Treatment options

Gastrostisis 2

The treatment for gastroschisis is surgery. Immediately after birth, the bowel will be placed in a sterile bag called a silo. The photo (right) illustrates the bowel in a silo. The tube will be passed either orally or nasally into the stomach to decompress the stomach, and intravenous (IV) lines will be placed to give the baby nutrients and antibiotics. The bowel will remain in the silo and be gradually returned to the abdomen; this takes approximately a week.

When the majority of bowel has returned to the abdomen, the baby will be taken to the operating room for surgery to close the abdominal wall. The baby will return to the NICU with a dressing over the abdomen, IV lines and an oral (OG) or nasogastric (NG) tube.

After surgery, bowel function will be monitored. Secretions from the nasogastric tube will be monitored to watch for color change. The baby’s bowel patterns will also be monitored. If bowel function has not returned two to three weeks after abdominal closure, a test will be performed to assess the bowel. Once bowel function has returned, the baby will gradually begin to be fed orally.

Feedings will be very small at first, but will increase in volume over a period of time that varies for each patient. The baby will be monitored for reflux, weight gain, etc., during this time. When goal weight gain and caloric intake with minimal or no side-effects are reached, the baby will be discharged from the hospital. The baby will be seen routinely by the surgeon for the first year of life to monitor growth and development and seen regularly by a pediatrician for immunizations and assessment of normal growth and development.


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