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350 Congenital Anterior Abdominal Wall Defects: Exomphalos and Gastroschisis Congenital Anterior Abdominal Wall Defects: Exomphalos and Gastroschisis
351 Congenital Anterior Abdominal Wall Defects: Exomphalos and Gastroschisis 351
Management of Gastroschisis Long delay before surgical intervention results in extrusion of more
Gastroschisis has a better prognosis than omphalocele because the evis- loops of bowel, which become oedematous and can be complicated
cerated bowel is usually a short loop of small intestine; the abdominal by gangrene of the long segment of loop of gut. Resection of the
cavity would in most cases accommodate the herniated gut. There are gangrenous segment leaves a short length of small intestine.
usually no other serious associated congenital abnormalities. Antenatal Diagnosis and Management
Most gastroschisis can be repaired by primary closure. The small
defect is extended, and exploration of the abdomen is done to exclude gut Omphalocele and gastroschisis can be detected early in pregnancy.
anomalies such as atresia or malrotation. The bowel is cleaned with warm Attempts to repair the defects intrauterine have not been successful.
saline and reduced into the abdominal cavity, and the wound is closed. The main usefulness of antenatal detection is to transfer the baby in
Gastroschisis is said to have occurred early in intrauterine life when utero to a paediatric surgical centre and institute early treatment soon
the bowel has stayed out for long time before birth. The eviscerated after birth. For large omphalocele, it may be preferred to deliver the
loops are usually covered with fibrinous exudates due to amniotic fluid baby by caesarean section to prevent rupture of the sac, which could
reaction. The abdominal cavity is usually small. Primary closure may occur during a normal vaginal delivery.
not be possible. A silo is useful; the gut gradually reduces and the defect
can then be closed.

Key Summary Points

1. Omphalocele has a sac and has associated abnormalities that 3. Primary repair has the best outcome; however, if this is not
contribute to the mortality and morbidity of the condition. possible, consider other modalities to avoid intraabdominal
2. Gastroschisis has no sac and has no associated abnormalities, compartment syndrome.
except possible bowel atresia. 4. Hypoglycaemia must be excluded in omphalocele.

Suggested Reading

Bruch WS, Langer JC. Omphalocele and gastroschisis. In: Puri P, ed. Sebakira J, Hadley GP. Gastroschisis: a third world perspective.
Newborn Surgery. Hodder Arnold, 2003. Pediatr Surg Int 2009; 25:327–329.
Patel G, Sadiq J, Shenker N, Impey L, Lakhoo K. Neonatal survival
of prenatally diagnosed exomphalos. Pediatr Surg Int 2009;
25(5):413–416.