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Emergency: requires immediate attention
Gastroschisis
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Gastroschisis

Contributors: Shea A. Nagle MPH, Abhijeet Waghray MD, Eric Ingerowski MD, FAAP
Other Resources UpToDate PubMed

Synopsis

Gastroschisis is an abdominal wall defect in neonates characterized by varying degrees of bowel herniation with the absence of a peritoneal membrane around the abdominal contents. The defect is usually to the right of the umbilicus. The pathogenesis of this particular abdominal wall defect is poorly understood as there are many existing hypotheses involving different steps of embryogenesis and organogenesis.

Risk factors include maternal smoking and recreational drug use during pregnancy as well as advanced or teenaged maternal age. Gastroschisis is not associated with any genetic disorders. Other congenital defects are rare, but 10%-20% of patients may develop intestinal atresia or malrotation.

Prenatal complications associated with gastroschisis include fetal growth restriction, polyhydramnios, preterm birth, and fetal demise. Dilation of the extra-abdominal bowel on ultrasound is associated with higher morbidity and complications. The mortality rate is around 10% but varies based on resources. These infants are at high risk for developing necrotizing enterocolitis in the first 3 months of life. Many infants have long-term gastrointestinal motility problems.

Codes

ICD10CM:
Q79.3 – Gastroschisis

SNOMEDCT:
72951007 – Gastroschisis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Omphalocele – herniated contents enclosed within peritoneal membrane, often associated with other defects and genetic conditions
  • Ruptured omphalocele – can be misdiagnosed as gastroschisis on ultrasound as the bowel may not be completely covered by a membrane
  • Hernia of the cord – bowel herniates into the base of the umbilical cord
  • Cloacal exstrophy / OEIS syndrome – omphalocele, exstrophy, imperforate anus, and spinal defect syndrome; characterized by herniated abdominal organs that separate 2 halves of the bladder, often associated with spina bifida
  • Limb-body wall complex – spectrum of congenital abnormalities including abdominal / chest wall and limb defects
  • Ectopia cordis – heart develops outside of the thorax
  • Urachal cyst – cyst that develops between umbilicus and bladder from patent urachus

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:06/12/2019
Last Updated:06/12/2019
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Emergency: requires immediate attention
Gastroschisis
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Gastroschisis
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