Diagnosis
In the developed world, around 90% of cases are identified during normal ultrasound screens, usually in the second trimester.Distinguished from other ventral body wall defects such as omphalocele, there is no overlying sac or peritoneum, and the defect is usually much smaller in gastroschisis. Treatment
Gastroschisis requires surgical treatment to return the exposed intestines to the abdominal cavity and close the hole in the abdomen. Sometimes this is done immediately but more often the exposed organs are covered with sterile drapings, and only later is the surgery done. Affected newborns frequently require more than one surgery, as only about 10% of cases can be closed in a single surgery. : 1141–1142 Given the urgent need for surgery after birth, it is recommended that delivery occur at a facility equipped for caring for these high-risk neonates, as transfers to other facilities may increase risk of adverse outcomes. There is no evidence that cesarean deliveries lead to better outcomes for babies with gastroschisis, so cesarean delivery is only considered if there are other indications.The main cause for lengthy recovery periods is the time taken for the infants bowel function to return to normal. After surgery infants are fed through IV fluids and gradually introduced to normal feeding. Prognosis
If left untreated, gastroschisis is fatal to the infant; however, in adequate settings the survival rate for treated infants is 90%.Most risks of gastroschisis are related to decreased bowel function. Sometimes blood flow to the exposed organs is impaired or there is less than the normal amount of intestine.
There may be genetic causes in some cases, and there may be environmental factors to which the mother is exposed during pregnancy.Risk factors include the mother being young, and use of alcohol or tobacco. Pathophysiology
During the fourth week of human embryonic development, the lateral body wall folds of the embryo meet at the midline and fuse together to form the anterior body wall. However, in gastroschisis and other anterior body wall defects, this fails to occur by either one or both of the lateral body wall folds not moving properly to meet with the other and fusing together. This incomplete fusion results in a defect that allows abdominal organs to protrude through the abdominal wall, and the intestines typically herniate through the rectus abdominis muscle, lying to the right of the umbilicus.