Summary

• Gastroschisis and omphalocele are defects of the abdominal wall that occur in utero, can be detected antenatally using fetal ultrasonography, and result in herniation of abdominal contents.
• In contrast to omphalocele, there is no sac covering the intestines in gastroschisis.
• The significant fluid balance changes and heat loss from exposed intestines in gastroschisis require emergency surgical intervention to establish abdominal wall closure or temporary coverage.
• The lack of a protective sac in gastroschisis exposes the intestines to amniotic fluid in utero, leading to a thick inflammatory film or peel overlying the intestine and causing delay of return of normal bowel function after closure.
• The most commonly associated anomaly of gastroschisis is intestinal atresia, which occurs in 10% to 15% of cases, and is related to ischaemia of the exposed gut caused by constriction of its mesenteric blood supply at the level of the abdominal wall defect.
• The most common cause of mortality in omphalocele relates to associated organ system and chromosomal anomalies such as pentalogy of Cantrell and Beckwith-Wiedemann syndrome, which are characterised by cardiac anomalies and chromosomal defects.
• Successful postnatal management of all abdominal wall defects is focused on timely abdominal wall closure, maintenance of euthermia, fluid resuscitation, and prevention of additional fluid loss from the abdominal contents, as well as prevention of ischaemia and infarction of the intestine.