Omphalocele and gastroschisis

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.

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.

Intestinal atresia, occurs in 10% to 15% of infants with gastroschisis, 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, temperature maintenance, fluid resuscitation, and prevention of additional fluid loss from the abdominal contents, as well as prevention of ischaemia and infarction of the intestine.

Gastroschisis and omphalocele are congenital defects of the abdominal wall resulting in intestinal herniation from the abdominal cavity. In contrast to omphalocele, there is no sac covering the intestines in gastroschisis. They can both be detected antenatally using fetal ultrasonography. Limited studies have attempted to categorise gastroschisis defects into subsets of simple or complex defects, with simple gastroschisis existing as an isolated defect, and complex gastroschisis occurring with other gastrointestinal anomalies such as intestinal atresia, perforation, necrosis, or volvulus.