Gastroschisis is an abnormality (defect or hole) in the abdominal wall that allows the abdominal contents to protrude outside the body. There is no peritomeal covering over the bowel or other contents. The defect is located to the right of the umbilicus (belly button/navel) and is completely separate from the umbilicus. The abnormality is usually very small, but the exposed contents can range from the stomach to the rectum (almost all of large and small bowel can become exposed). The stomach may be involved but not the liver.


Gastroschisis has no sac covering the exposed contents.
It occurs in the first born 74% of the time.
The malformation is always obvious at birth and able to be seen as early as 14 weeks of pregnancy
the associated problems are :

prematurity (55%)
intra uterine growth retardation (77%)
cardiac problems
minor malformations in small bowel, may be a part of the gastroschisis itself
intestine shortened to as much as one third of the normal length.
In gastroschisis, the bowel is not contained, but floats freely with the amniotic fluid. Contact with amniotic fluid may cause severe damage to the bowel, which suffers growth failure, becoming thickened, matted, shortened and with poor mucosal function. This damage become more severe with prolonged exposure to amniotic fluid, and accelerates from thirty-five weeks gestation.

Some centres suggested that early delivery by cesarean section limited the bowel damage, with subsequent shortening of hospital stay and time of tpn (total parenteral nutrition ; feeding completely via a drip). Some centres also perform weekly ultrasounds from thirty weeks, looking at the bowel wall thickness and when there is ultrasound evidence that the bowel wall is becoming thickened, the baby is then delivered by cesarean section. Such centres advocate planned cesarean section, sometimes ultrasound guided, to limit bowel damage.


There have been no studies that have conclusively proven the theoretical benefits of early delivery of babies with gastroschisis via cesarean section. They have not shown that there are post-natal benefits of early cesarean section, whether in terms of appearance or function of the bowel, nor in terms of hospital stay or length of tpn. There are many studies claiming there are no significant benefits of early caesarean section over vaginal delivery at term (> 37 weeks).


The current policy of the department of paediatric surgery at the prince of wales children's hospital is that babies with gastroschisis, diagnosed on antenatal ultrasound, be allowed to proceed to normal delivery under normal obstetric guidelines and we do not consider that early delivery by caesarean section offers any benefit to the baby, the mother or the health care system. There are also no data to support the performance of weekly ultrasounds, unless this were part of an ongoing study. This policy is also partly based on the knowledge that babies with gastroschisis very frequently are born at about thirty-six to thirty-eight weeks gestation, and in overseas studies, many planned cesarean sections were pre-empted by spontaneous onset of labour.


There are proven advantages to the baby if skilled paediatric care is available at the time of delivery; to minimize any secondary trauma to the bowel and to prevent the rapid heat, fluid and electrolyte loss problems that these babies are prone to. Operation is performed as soon as possible after delivery, which in practice means after rapid stabilisation and transport. Primary closure is the ideal, but other techniques such as use of silastic, silon, gore-tex patch or skin closure only can be employed to rapidly cover the exposed bowel. The median time to full oral intake at prince of wales children's hospital is around four weeks, with considerable spread either side.


If the baby has not been born in the hospital where surgery is available it will need to be transported by the net (neonatal emergency team). Before the net transport team arrives the abnormality should be covered with sterile plastic film. Wet gauze dressings can become cold and increase heat loss, absorbs fluid from the abdomen, and leaves lint ). The plastic film does not grow organisms (bacteria) and provides an artificial skin --- the first line against infection.

There is much interest amongst paediatric surgeons in this topic, and the management of antenatally diagnosed surgical conditions generally. Therefore, as more studies are published and experiences gained, the optimal management of antenatally diagnosed conditions, including gastroschisis, may change. The optimal management of such babies may also change when the obstetric and paediatric surgical services are on the same site, and so continual liaison is required to implement these changes. Therefore, it would be desirable if paediatric surgeons be consulted when surgical conditions are diagnosed antenatally.


Before operation the baby will have a feeding tube inserted through the baby's nose (strapped to the side of the nose with tape) which goes into the stomach and is left to drain into a container. This fluid will be measured and the amount replaced hourly with a special solution ordered by the medical officer.

A drip will be inserted into the baby's arm or leg after delivery to allow the baby to receive intravenous fluids. The baby will not be allowed any oral food (nil by mouth) from delivery and a strict measurement of all fluid losses will be done and recorded on the baby's charts. The plastic film covering the defect will be kept intact until the operation. During this time the baby will be nursed in a open cot with overhead heater or in isolette (humidicrib) .


Various blood tests will be done on admission and maybe a chest-x-ray -- blood gases, electrolytes etc. A heart monitor to record the baby's heart, pulse and perhaps a pulse oximeter to record oxygen levels will be attached to the baby on admission.


Surgical correction of the abnormality will be done as soon as the infant's condition is stabilised. This surgery is done as soon as possible to minimise risks.


Surgical management

primary (complete repair with the first operation) repair can occur when the abnormality is small , this is in approximately 80% of cases where the abdominal wall can be closed completely.


If the abnormality is large the surgeon may decide to cover the area with a silastic silo, this will enable as much bowel as possible to be returned to the abdominal cavity during the operation. The remainder of the abnormality is left out, and is covered with silastic. The silastic silo is suspended to the top of the isolette or over - head heater, thus allowing gravity and daily manual compression of the abnormality to aid the reduction process. This procedure is done in the unit. The skin around the silo is covered with op-site (sterile clear plastic dressing) to protect it.


After the operation:

when the baby returns from the operating theatre, it will be nursed in the intensive care unit in an open bed or a isolette.


Most infants with this abnormality return from the operating a theatre with a central line (hickmann's or broviac catheter ) inserted into the chest area, this enables the infant to be given a period of total parental nutrition (alimentation ). T.P.N. Solution is used for nutrition until the infant can absorb and tolerate breast milk or formula. This solution is given through the central line via a pump. The baby may require t.P.N. For a few weeks depending on how long it takes for the baby to tolerate the milk.


The t.P.N. Solution is ordered by the medical staff daily, and changed each day by the nursing staff. As milk begins to be tolerated by the infant, the amount of t.P.N. Is reduced.



There is no way to predict if your child will ahve this problem or not. It has nothing to do with the mother or father, just the way that the baby develops in the womb.

I hope this helps you out. !!
-jen