Which clinical history findings are characteristic of pediatric gastroschisis?

Updated: Nov 05, 2019
  • Author: James G Glasser, MD, MA, FACS; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Answer

The abdominal wall defect of gastroschisis is generally uniform in size (≤5 cm) and constant in location (right of the umbilical cord).

The amount of inflammation of the extruded intestine varies. Inflammation may be minimal, or it may distort the appearance of the bowel, obscuring the anatomy and making it difficult even to identify an atresia. See the images below.

Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). Inflammatory distortion of the extruded intestine is shown. There appears to be an associated atresia (the dilated intestine), but this resolved in concert with resolution of the inflammation.
Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). This infant has gastroschisis and colon atresia, with the proximal end open. An ostomy is brought out of the silo.
Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). The sac is removed, and the abdominal wall defect is closed around the in utero colostomy.

The amount of inflammation, the distribution of meconium (whether it can be evacuated manually through the anus), or whether succus entericus can be milked into the stomach and suctioned (by anesthesia), are factors that determine whether reduction and closure of the abdominal wall defect can be accomplished primarily or whether a "silo" must be used.

When primary closure of the abdominal wall defect is not possible, a silo is utilized to contain the intestine until the inflammation has resolved and it becomes soft and pliable. Usually, reduction be accomplished within 1 week. Correction of intestinal atresia, by either an anastomosis or an enterostomy, is best delayed until closure of the abdominal cavity has been achieved.

Intestinal dysfunction, delaying the onset of feedings, may take 4-6 weeks to resolve.

When gastroschisis is identified antenatally, serial ultrasonography is performed to identify compromise to the intestinal viability.

Concomitantly, amniocentesis monitors lung maturity and signals when to induce labor. [33, 34, 35, 36, 37]


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