What Is Gastroschisis?
Gastroschisis is a condition that develops when the fetus is still inside the mother’s womb. An opening is formed in the abdominal wall of the baby through which intestines come outside and grow in the amniotic fluid. Since the intestines grow outside the body they are not well protected leading to infections, trauma, swelling, and damage of the intestine. The orifice is about one to two inches in diameter and is present on the right side of the belly button. In mild cases of gastroschisis, only the intestines protrude outside, whereas in severe cases, intestines along with the stomach and liver also project outside from the hole.
What Are the Causes of Gastroschisis?
The etiology of gastroschisis is unknown, it develops around the fourth to eighth week of the gestational period. The weakened abdominal wall around the umbilical cord leads to the formation of gastroschisis and the presence of gastroschisis in the fetus does not cause any harm to the mother during pregnancy. It is not an inherited condition, and if the first child is having gastroschisis it does not mean that the second child could also be affected by gastroschisis.
How to Diagnose Gastroschisis?
Gastroschisis develops early during the fourth to eighth week of pregnancy, but it is diagnosed by routine ultrasound that is carried out at regular check-ups at around16th week to 20th week of the gestation period. Ultrasounds of the fetus that are affected by gastroschisis show loops of the intestine that are floating freely in the amniotic fluid.
After the diagnosis of gastroschisis, the fetus should be evaluated for a heartbeat by performing a fetal echocardiogram (sound waves are used to detect the fetus's heartbeat, this also shows how well the heart is performing in an unborn baby). In the next step, the mother is asked to consult a genetic counselor. Delivery of the woman who is carrying a gastroschisis baby is carried out under the supervision of a pediatric surgeon, neonatologist, and fetal medicine specialist.
Differential diagnoses of gastroschisis include omphalocele - A rare congenital anomaly where the liver and intestines remain outside in a bag. Since major abdominal organs remain outside the body, the stomach does not grow to its normal size and remains smaller in size, the unborn baby's stomach appears to be filled with clear liquid as major organs like the stomach, intestine, and liver remain outside the abdomen.
How to Treat Gastroschisis?
Gastroschisis refers to a fatal situation of the newborn baby and it should be treated immediately after the birth of the baby. Gastroschisis repair is the method by which the gastroschisis is corrected, otherwise, the organs such as the small intestine and stomach would bump outside the belly. The treatment is usually carried out in two ways depending on the intensity of protrusion of abdominal organs. The two ways include:
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Primary Repair: The surgery is carried out on the same day the baby is born, primary repair is indicated only when a small amount of intestinal tissue bulges outside the abdominal cavity through a hole. Primary repair is contraindicated if the intestine appears to be swollen, injured, or damaged. After the birth of the baby, the hanging abdominal organs are wrapped to protect them from external injury. And then the baby is shifted to the operation theater.
In the operation theater, the baby is induced with general anesthesia which makes the baby sleep and is pain-free during the entire operation time. The pediatric surgeon closely and carefully observes for any damaged or diseased parts of the small intestine (bowel). The damaged parts of the small bowel are removed and the healthy edges of the bowel are ligated together. After this the repaired small bowel is placed inside the abdominal cavity and suturing is done over the abdominal cavity.
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Stagged Repair: Stagged repair is indicated when there is a large amount of small intestine hanging outside the abdominal cavity when the protruded small intestine is swollen, and when the baby’s belly is too small to accommodate the hanging intestines outside the body.
After the baby’s birth, the large hanging intestine is completely wrapped inside a long plastic pouch known as the silo, and then one end of the silo is attached to the belly of the baby and the other is left to hang outside the baby’s abdomen. Gravity pushes the small intestine in the silo to slip back into the abdomen slowly, doctor tightens the silo daily so that overhanging intestines are slowly pushed back into the abdomen.
Nearly two weeks of time is needed for all the contents present in the silo to empty back into the belly of the baby, then the doctor removes the silo, and the abdominal opening is sutured off. In some cases, the baby might require further treatments to correct the muscles in the abdominal cavity.
What Are the Complications Involved in Gastroschisis Repair?
Gastroschisis is a life-threatening condition and must be treated immediately after the birth of the child. surgical repair would involve certain complications which include:
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Anesthetic Effects: Medicines that are used in anesthesia show certain allergic reactions in newborns.
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Bleeding and Infections: These two are the most common complications of any surgery and gastroschisis is not an exception.
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Breathing Difficulties: If the newborn baby's abdominal space is too less then the child may face certain breathing issues, therefore the baby is supported with a breathing tube (endotracheal tube) or placed on an artificial breathing machine for a few days after the surgery.
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Swelling: Usually signs of inflammation (redness, swelling, pain) are noticed along the walls of the abdomen and abdominal organs post-surgery.
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Indigestion: After the surgical repair of gastroschisis some babies find difficulty in digestion and absorption of nutrients from the food in the small intestine. This is especially seen in babies if there is large damage and destruction to the small intestine.
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Hernia: Abdominal hernia (sac formed by the abdominal cavity lining) is seen in some cases.
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Sometimes muscles in the small intestine stop their movement leading to temporary paralysis of the small intestine.
Conclusion
Gastroschisis appears to be a scary situation for the parents since it is very hard for the parents to see their babies with the overhanging intestines over the belly region. After the surgical repair of gastroschisis, the prognosis is very positive, and the babies with gastroschisis progress well and lead normal life.
