Gastroschisis

The gastroschisis (Greek γαστροσχίσις, Gastro ~, " ~ stomach, stomach ~" and s-chísis/s-chísma, " cleavage " ) is a prenatal (prenatal ) spontaneously arising mostly from the navel to the right location malformation of the abdominal wall with prolapse of loops of bowel in the fetus called. The peculiarity is often diagnosed by ultrasound fine in the context of prenatal diagnosis and is postnatal ( postnatal) in most cases operable.

Formation

The origin of gastroschisis is not yet clear as before. We discuss two main theses:

• During pregnancy, parts of the intestines move from the stomach in a ballooning of the umbilical cord. Bursts of this bag, it can lead to gastroschisis, the corresponding organs then swim freely in the amniotic fluid.
• The other thesis is that a vascular malformation of the abdominal wall causes these rises and thus resulting in a hole in the abdominal wall.

According to a study, the risk of gastroschisis is increasing with the newborn in smoking pregnant women by 50 percent compared to non-smoking pregnant women.

Associated malformations

In contrast to omphalocele associated malformations often affect in gastroschisis only the intestine, there are mainly intestinal atresias, ie non-continuous points of the intestine. Spontaneous reduction of the gap in the abdominal wall may lead to a disconnection of the vascular supply of the external parts of the intestine with the fall of the same and a loss of larger parts of the intestine.

Diagnostics

Even before birth, the gastroschisis ultrasound detected.

After birth, shows the typical malformation of the anterior abdominal wall with the outer loops of bowel.

Procedure

The pregnancy with an established gastroschisis in the child should be monitored by appropriate specialists, so a spontaneous shrinking the gap in the abdominal wall is noticed in time. Since the remaining outside organs are located in the amniotic fluid and can be damaged by the increasing concentration of child excreta is a planned birth is usually performed before the actual date. The two goals, " maximum maturity of the newborn " and " minimal damage to organs " have to be weighed.

Some centers are currently discussing the exchange of amniotic fluid in order to minimize the gut -depleting substances contained therein.

Frequently at birth a caesarean section is performed. The birth should be done in a center with attached Neonatal Intensive Care Unit and Pediatric Surgery.

Within the first few hours after birth, a first surgical treatment of the newborn child is carried in order to protect the external loops of bowel from infection. It is either the direct surgical treatment carried out, in which the intestinal loops placed directly into the stomach, possible associated malformations - if visible - corrected and the abdominal wall is closed. In recent times, can also first be done in the intensive care unit, the displacement of the intestines in a sterile plastic bag, which is fixed to the abdominal wall and is suspended over the child. In the following days, the intestinal loops then slip according to gravity into the abdominal cavity, the gap can then be easily closed with a few sutures.

If a direct surgical treatment carried out, it is possible with appropriate experience of the clinic, in most cases, completely displacing the bowel loops in the first operation in the abdomen and close the abdominal wall without foreign material. Must foreign material can be used during the operation, as the abdominal cavity is too small, this later in one or more subsequent operations will be removed. Intestinal obstruction ( ileus) are a common complication.

Course and prognosis

The postoperative enteral nutrition can be very long ( sometimes several weeks). During this time the children get all the necessary nutritional components via an infusion.

Overall, the children have a very good prognosis.