gastroschisis

Gastroschisis is a congenital defect in which the intestines and sometimes other abdominal organs herniate through a defect in the anterior abdominal wall, usually to the right of the umbilicus. The protruding viscera are not covered by a protective sac, and they are exposed to amniotic fluid and mechanical irritation.

Most cases are isolated and diagnosed prenatally or at birth. The estimated incidence ranges from about 1 in 2,000 to 1 in 5,000 live births. Risk factors include younger maternal age and cigarette smoking; the exact cause is not fully understood but may involve disruption of abdominal wall development and vascular injury in utero. Associated anomalies occur in a minority of cases, more often with other congenital defects.

Prenatal ultrasound can reveal an abdominal wall defect with free-floating loops of bowel; after birth, the appearance of everted bowel outside the abdomen supports the diagnosis. Additional imaging may be used to assess organ viability and associated conditions.

Management begins with protecting the exposed bowel, typically by covering it with sterile moist dressings and obtaining prompt surgical input. Treatment options include primary closure for small defects or staged repair using a silo to gradually reduce the viscera, followed by definitive closure. Nutritional support with parenteral nutrition is common, and careful fluid management and infection control are important.

Prognosis is generally favorable with modern neonatal surgical care, but depends on the amount of bowel exposed and its viability. Complications can include short bowel syndrome, prolonged hospitalization, and bowel dysfunction. Long-term follow-up with pediatric surgery and gastroenterology is common.