APSA Gastroschisis Brochure FNL

American Pediatric Surgical Association
Prenatal Counseling Series

Gastroschisis
from the
Fetal Diagnosis and Treatment Committee
of the American Pediatric Surgical Association
Editor-in-Chief: Ahmed I. Marwan, MD
Special thanks to: Oliver Muensterer, MD,
and Jill Stein, MD
TM
©2018, American Pediatric Surgical Association


Gastroschisis
Definition and Differential Diagnosis

• Gastroschisis is a condition in which the abdominal wall does not form correctly
during development.
• It results in a defect of varying size mostly to the right side of where the umbilical
cord attaches to the baby.
• Protruding organs may include: small bowel, together with large bowel, stomach,
liver, bladder, as well as the ovaries and fallopian tubes in females.
Axial ultrasound images show an abdominal wall defect with multiple loops of non-dilated bowel located
external to the fetal abdomen. The defect is most commonly located to the right of the umbilicus. No overlying
membrane is seen. Courtesy of Jill Stein, MD – Colorado Fetal Care Center – Children’s Hospital Colorado
• In contrast to omphalocele, a similar condition that occurs in the midline of the
baby rather than the right side, the organs in gastroschisis are not covered by a
sack or membrane.

Gastroschisis
Sagittal MRI image of a 22-week-gestation

fetus with an abdominal wall defect adjacent
to the umbilicus. Multiple loops of non-
dilated bowel are protruding external to the
abdomen without overlying membrane.
Courtesy of Jill Stein, MD – Colorado Fetal
Care Center – Children’s Hospital Colorado
• Outer surface of the bowel is exposed to the amniotic fluid, which usually leads to
inflammation and thickening of the wall, causing the bowel not to work correctly
for several weeks after birth, even if the protruding content is brought back to the
belly and the defect is closed. During this time, the newborn baby needs to be fed
intravenously rather than through the gut.
• Gastroschisis happens in as many as 1 out of 2,000 births.

• The risk factors are maternal young age and smoking. Overall, the incidence
seems to have increased over the last decades.
Prenatal Diagnosis
• Gastroschisis can be detected by prenatal ultrasound in as early as the 12th week of
pregnancy. Typically, the defect is detected to the right side of the cord insertion.
• It is mostly an isolated defect, however associated intestinal atresia may be seen.
• Alfa-Fetoprotein (AFP) levels in the blood are usually evelated in mothers carrying
a fetus with gastroschisis. Most often, there are no specific genetic anomalies
detected in affected babies.

Gastroschisis
Prenatal Considerations
Once a prenatal diagnosis of gastroschisis is established, birth should be planned in
a specialized center that incorporates high-risk obstetrics, neonatology and pediatric
surgery. Some babies with gastroschisis are growth restricted, and some are born
prematurely. The goal, however, should be to allow the pregnancy to progress to 38
weeks before birth. Current studies suggest that babies with gastroschisis can be
born safely via a normal vaginal delivery if there are no other factors that warrant a
cesarean section.
• Close antenatal surveillance is recommended due to the possibility of late

gestational fetal demise.
• Dilated thickened bowel loops may be related to complicated gastroschisis,

however this is neither sensitive nor specific.
Ultrasound images of multiple loops
of bowel located external to the fetal
abdomen that are mildly dilated with
diffuse wall thickening.
Courtesy of Jill Stein, MD – Colorado
Fetal Care Center – Children’s Hospital
Colorado
• When counselling families, it is important to introduce the concept of simple versus

complicated gastroschisis.
• Complicated gastroschisis may be due to associated intestinal atresia, in utero

volvulus, or chronic intesintal pseudo-obstruction.

Gastroschisis
Delivery and Post-natal Considerations

Neonatal Transition
• Gently wrap the protruding organs in moist sterile dressings and then place the
entire body from the nipples downward in a sterile clear plastic bag to protect them.
• Transfer to the neonatal intensive care unit.

• Judicious intravenous fluid resuscitation balancing insensible fluid losses, neonatal
fluid status and kidney function and iatrogenic bowel wall edema.
• Full examination by the pediatric surgeon to determine if a primary repair is

feasible, or if a silo bag should be placed (depending on the degree of
viscero-abdominal disproportion).
Management of Simple Gastroschisis

• When primary repair is possible, the organs will be returned to the abdomen and
the defect is closed either surgically or via a sutureless umbilical cord patch.
• Otherwise, the organs will be placed in the silo, and gently brought into the belly
over the following few days, until closure is possible.
• Parenteral nutrition via a central venous line until the bowel starts working. This may
take several weeks and requires a lot of patience.
Management of Compicated Gastroschisis

• Initial mangement is similar to simple gastroschisis.
• Sometimes the diagnosis of associated intestinal atresia is not apparent at first.
• Various approaches are available for management of these babies including
delayed surgical correction after initial closure, immediate definitive surgical
correction or temporary decompression via a stoma.
Other Post-natal Considerations

• Some boys with gastroschisis have undescended testicles, which need to be
corrected at a later time.

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American Pediatric Surgical Association

Prenatal Counseling Series

©2018, American Pediatric Surgical Association

Prenatal Counseling Series

Definition and Differential Diagnosis

Prenatal Counseling Series

Sagittal MRI image of a 22-week-gestation

• Gastroschisis happens in as many as 1 out of 2,000 births.

Prenatal Counseling Series

• Close antenatal surveillance is recommended due to the possibility of late

• Dilated thickened bowel loops may be related to complicated gastroschisis,

• When counselling families, it is important to introduce the concept of simple versus

• Complicated gastroschisis may be due to associated intestinal atresia, in utero

Prenatal Counseling Series

Delivery and Post-natal Considerations

• Transfer to the neonatal intensive care unit.

• Full examination by the pediatric surgeon to determine if a primary repair is

Management of Simple Gastroschisis

Management of Compicated Gastroschisis

Other Post-natal Considerations

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• Gastroschisis happens in as many as 1 out of 2,000 births.

• Close antenatal surveillance is recommended due to the possibility of late

• Dilated thickened bowel loops may be related to complicated gastroschisis,

• When counselling families, it is important to introduce the concept of simple versus

• Complicated gastroschisis may be due to associated intestinal atresia, in utero

• Transfer to the neonatal intensive care unit.

• Full examination by the pediatric surgeon to determine if a primary repair is