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Gastroschisis

Aka: Gastroschisis

I. See Also

  1. Omphalocele

II. Definition

  1. Open peri-umbilical abdominal wall defect in newborns

III. Epidemiology

  1. Overall Incidence: 1 in 10,000 births
  2. Incidence in mothers under age 20: 7 in 10,000 births

IV. Risk factors

  1. Intrauterine Growth Retardation
  2. Prematurity
  3. Young mother (under age 20)

V. Pathophysiology

  1. Abdominal wall defect lateral to Umbilicus
  2. Evisceration of Small Intestine and ascending colon
  3. Bowel abnormal - matted and thickened

VI. Associated Conditions (21% of cases)

  1. Intestinal atresia
  2. Gallbladder agenesis
  3. Renal agenesis

VII. Diagnosis

  1. Usually diagnosed by prenatal Obstetric Ultrasound

VIII. Management

  1. Stabilization
    1. Apply warm fluid-impermeable dressing over defect
      1. Avoid excessively Wet Dressings (macerates bowel)
      2. Place lower half of baby in sterile bowel bag
    2. Orogastric Tube for decompression
    3. Fluid Resuscitation (high evaporative losses)
      1. Maintenance IV fluids: D10W or 1/4NS
      2. Start with 20 cc/kg bolus over 30 minutes
      3. Fluid requirements in Gastroschisis 2.5x normal
    4. Blood Culture
    5. Broad spectrum antibiotic coverage
      1. Ampicillin 100 mg/kg/day and
      2. Gentamicin 5 mg/kg/day
  2. Surgical repair on first day of life
  3. Parenteral Feeding

IX. Complications

  1. Necrotizing Enterocolitis
  2. Bowel perforation

X. Prognosis

  1. Mortality: 10%

XI. References

  1. Feldman (1998) Sleisenger Gastrointestinal, p. 1428
  2. Townsend (2001) Sabiston Surgery, Saunders, p. 1479-80
  3. Fuloria (2002) Am Fam Physician 65(2):265-70 [PubMed]

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Ontology: Gastroschisis (C0265706)

Definition (NCI) A congenital birth defect characterized by the exposure of the fetal intestines outside the abdominal wall through an abdominal wall opening.
Definition (MSH) A congenital defect with major fissure in the ABDOMINAL WALL lateral to, but not at, the UMBILICUS. This results in the extrusion of VISCERA. Unlike OMPHALOCELE, herniated structures in gastroschisis are not covered by a sac or PERITONEUM.
Concepts Congenital Abnormality (T019) , Disease or Syndrome (T047)
MSH D020139
ICD9 756.73
ICD10 Q79.3
SnomedCT 72951007
LNC LA19590-1
English Gastroschisis, GASTROSCHISIS, Gastroschises, gastroschisis (diagnosis), gastroschisis, Congenital Fissure of the Abdominal Cavity, Gastroschisis [Disease/Finding], gastroschises, Gastroschisis (disorder)
Swedish Gastroschis
Japanese ﾌｸ�ｷﾊﾚﾂ, 腹�破裂, 胃�破裂, 胃�披裂, 腹�披裂, 腹�破裂症, 腹�裂, 腹�裂症, 腹裂
Czech gastroschiza, Gastroschíza, gastroschíza, rozštěp stěny břišní, porucha uzávěru břišní stěny
Finnish Vatsahalkio
Russian GASTROSHIZIS, Г�СТРОШИЗИС
Korean 위벽파열
Croatian GASTROSHIZA
French Fissure congénitale de la paroi abdominale, Fissure de la paroi abdominale, Fente de la paroi abdominale, Fente congénitale de la paroi abdominale, Gastroschisis, Laparoschisis
Polish Wytrzewienie wrodzone, Wrodzone wytrzewienie, Wrodzona szczelina ściany brzucha, Szczelina żołądkowa
Hungarian Gastroschisis
Norwegian Gastroschise
Spanish fisura congénita de la pared del vientre, gastrosquisis (trastorno), gastrosquisis, hendidura congénita de la pared del vientre, Gastrosquisis
Dutch gastroschisis, Gastroschisis
German Gastroschisis
Italian Gastroschisi
Portuguese Gastrosquise
Derived from the NIH UMLS (Unified Medical Language System)

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