Gastroschisis is protrusion of the abdominal viscera through a full-thickness abdominal wall defect, usually to the right of the umbilical cord insertion.
(See also Overview of Congenital Gastrointestinal Anomalies.)
The estimated incidence is 1 in 2500 live births (more common than omphalocele, in which the abdominal viscera protrude from a midline defect at the base of the umbilicus) (1). In gastroschisis, unlike omphalocele, there is no membranous covering over the intestine, which is markedly edematous and erythematous and is often enclosed in a fibrin mat. These findings indicate long-standing inflammation due to the intestine being directly exposed to amniotic fluid (ie, chemical peritonitis). Infants with gastroschisis have low incidence of associated congenital anomalies (10 to 15%) other than gastrointestinal abnormalities such as malrotation and intestinal atresia, which occur in approximately 25% of cases (2, 3).
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Gastroschisis can be suspected before birth by abnormally high alpha-fetoprotein levels on prenatal blood tests and can be detected by prenatal ultrasonography (4); when confirmed, delivery should take place at a tertiary care center.
The infant is evaluated for associated anomalies before surgical repair. Primary closure is done when feasible. When a large amount of bowel is exposed, the abdominal cavity may be too small to accommodate the viscera. In this case, the viscera are covered by a pouch or silo of polymeric silicone sheeting, which is progressively reduced in size over several days as the abdominal capacity slowly increases, until all of the viscera are enclosed within the abdominal cavity. More recently, sutureless repair of gastroschisis has been done using the umbilical cord or a synthetic dressing to cover the defect. More research is required to assess the effectiveness of this approach.
It often takes several weeks before gastrointestinal function recovers and oral feedings can be given; occasionally, infants have long-term problems caused by abnormal intestinal motility.
References
1. Friedman AM, Ananth CV, Siddiq Z, et al: Gastroschisis: epidemiology and mode of delivery, 2005-2013. Am J Obstet Gynecol 215(3):348.e1-348.e3489, 2016. doi:10.1016/j.ajog.2016.03.039
2. Mastroiacovo P, Lisi A, Castilla EE, et al: Gastroschisis and associated defects: An international study. Am J Med Genet A 143A(7):660-671, 2007. doi: 10.1002/ajmg.a.31607
3. Abdullah F, Arnold MA, Nabaweesi R, et al: Gastroschisis in the United States 1988-2003: Analysis and risk categorization of 4344 patients. J Perinatol 27(1):50-55, 2007. doi: 10.1038/sj.jp.7211616
4. Bence CM, Wagner AJ: Abdominal wall defects. Transl Pediatr 10(5):1461-1469, 2021. doi:10.21037/tp-20-94
