Brown University

Fetal Medicine @ Brown
WARREN ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY

The Warren Alpert Medical School of Brown University

Abdominal Wall Defects:
Gastroschisis
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WHAT'S GASTROSCHISIS?

WHAT'S OMPHALOCELE?

SUPPORT GROUPS

GLOSSARY

The text below will, hopefully, answer some of the questions you may have regarding this condition. You can scroll down, or go directly to a specific question:

Underlined terms are explained in detail - just click on them. A medical review on this topic was recently published by Dr. Kurkchubasche in Medicine & Health/Rhode Island.

WHAT WILL HAPPEN AT BIRTH?

If everything goes as planned, you will deliver at a tertiary care center with direct access to a neonatal intensive care unit. The neonatologists will be present at delivery, so that they can immediately assess your baby and start treatment, if necessary. At the same time, the pediatric surgeons will be alerted, so that surgical correction can be performed as soon as possible. In most cases, however, you will be able to see (and hold) your baby after delivery.

Your baby will be "stabilized" in the intensive care unit. An intravenous line will be placed in an arm or a leg, so that fluids can be given. Because of the exposed intestines, your baby is likely to lose a lot of fluid by evaporation, and is likely to cool off more rapidly as well. Your baby will therefore be placed under a warmer, and the loops of bowel will be carefully wrapped to protect them from the outside. If you baby shows signs of distress, it is possible that he will be intubated, so that we can help him breathe better.

Once it is clear that there are no other major problems, your baby will be ready to undergo surgical repair of the defect. How this is done will depend on how much intestines and other organs are exposed, and how big your baby is. In many cases, all the intestines can safely be placed back in the abdomen (so-called "primary repair"), and the abdominal wall can be closed. Primary repair of gastroschisisOf course, this is done in the operating room with your baby under anesthesia. Often, however, there is so much out that this cannot be safely replaced all at once. In that case, we try at least to protect the intestines until they are ready to be put back in the abdomen. For this, we place a "silo" (a clear plastic or silicone pouch) over the intestines, so that they are now shielded from trauma, infection and dehydration. This can be done at the bedside, in the intensive care unit, or in the operating room.

Once the swelling has gone down and the abdomen has become used to the presence of more bowel, the silo can be removed and the abdomen closed over the intestines. This typically takes a few days to a week.

 

WHAT HAPPENS NEXT?

As mentioned before, the intestines have suffered somewhat during pregnancy, and they will need some time to recover. On average, it may take 2 to 3 weeks before the intestinal tract functions properly again. During that time, your baby will be fed through the veins only, by "total parenteral nutrition," or TPN. He will get all the calories necessary to grow, until he can be fed by mouth again. Once gut function returns, it will likely take a while before your baby can tolerate full feeds, and that nutrition through the veins can be stopped. Your baby is likely to stay in the hospital for at least 1 month. Sometimes, this can be much longer, depending on the degree of prematurity and the condition of the bowel.

 

COMPLICATIONS AND LONG-TERM OUTCOME

The overall outcome of gastroschisis is excellent: some infants may have minor intestinal problems in the first few months, but will recover from that and lead a completely normal life. Although the belly button may not look perfectly normal, there should be minimal scarring.

In some rare cases, however, there may be some complications. While gastroschisis is usually not associated with other anomalies, there may be intestinal defects in 5 to 10%. These represent in utero "accidents," where a piece of intestine becomes necrotic and disappears. As a result, there may be a missing portion of intestine (intestinal atresia), which will have to be fixed. Often, this is not discovered until a few weeks after birth. An additional operation will then be necessary. Very rarely, a large portion of intestine suffers and dies off. In those rare instances, bowel function may suffer.

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