Gastroschisis Pathogenesis

Gastroschisis is a birth defect of the abdominal wall, which is not fully formed when a child is born. The abdominal contents protrude through a gap in the abdominal wall and are exposed to the outside of the body and vulnerable to infection.

Gastroschisis requires prompt surgical management as soon as a baby is born. The type and extent of the operation depends on the amount of intestine outside the abdomen as well as the space available to fit the intestine back inside the abdominal cavity.

Overall, children born with this condition have an excellent prognosis and today, the survival rate is around 90% to 95%.

In many cases, the condition is detected during a prenatal check using ultrasound scanning, which allows time to plan the birth and discuss the best way to manage the condition. Once the baby is born, the exposed bowel is immediately covered with a sterile material and the baby is administered fluids using a drip. A tube is used to drain away bile from the stomach and reduce the risk of vomiting during surgery. The baby is usually anesthetized within 24 hours of birth and an operation is performed to place the exposed intestine back inside the cavity and seal the hole in the abdominal wall.

Sometimes it is not possible to place the entire intestine back inside the cavity in one operation and the procedure needs to be performed in stages. For a staged repair, the surgeon places a mesh over the intestine to contain and protect it. This is then suspended above the child and gravity eventually moves the intestine back down inside the abdomen. The mesh sac is tightened regularly until all of the intestine has moved back into the abdomen.