Gastroschisis

With gastroschisis, gastro- refers to the gastrointestinal tract, and -schisis refers to separation; so in gastroschisis, the anterior abdominal wall fails to close and remains open or separated throughout fetal development, and this results in a newborn’s abdominal organs, often the intestines, protruding out and being exposed to the outside environment.

Now, during the fourth week of fetal development, the embryo starts to change shape from a flat, three-layer disc to something closer to a cylinder, called embryonic folding, Looking at the embryo in the horizontal plane, the two lateral folds eventually come together and close off at the midline, except for one tiny spot where the umbilical cord connects the fetus to the placenta.

That opening later becomes the umbilicus, also known as the belly button. This folding allows for the formation of the gut within the abdominal cavity.

With gastroschisis, those lateral folds don’t close all the way, essentially leaving an opening in the abdominal wall. The hole almost always extends through the rectus muscle to the right of the umbilicus, although it’s not really known why it tends to be on the right side.

Whatever the reason is, this opening allows the developing organs to protrude through into the amniotic sac. Exposing the abdominal organs to amniotic fluid can sometimes cause the intestines to get irritated and inflamed, which can lead to malabsorption issues.

Following delivery in gastroschisis, the bowels are exposed and they’re not covered by a peritoneal layer. In contrast to this, there is a related condition called an omphalocele, which is where the abdominal contents protrude into the umbilical cord, meaning that in this case they are sealed by the peritoneal layer of the umbilical cord and are not exposed to the amniotic fluid.

Although the cause of gastroschisis isn’t known, it’s thought to potentially be caused by reduced blood supply to the abdominal wall during fetal development, and it’s likely that both genetic and environmental factors play a role.

Some factors that seem to increase the risk of having a baby with gastroschisis, include young maternal age, as well as consuming alcohol and tobacco during the pregnancy.

Diagnosis before birth might be done via ultrasound or blood tests. In which case an increased maternal serum alpha-fetoprotein is associated with abdominal wall defects.

Treatment of gastroschisis involves surgery following birth, in which the intestines and organs need to be placed back in the body and the defect repaired.

If the defect is large and involves multiple organs, then they might have to be slowly moved back into the abdominal cavity.

Newborns might also need additional treatments, like intravenous nutrients and antibiotics to manage infections. Alright, as a quick recap, gastroschisis is a condition in which the abdominal wall fails to close, leaving a hole typically to the right of the umbilicus, which results in the abdominal organs protruding out; in contrast to omphaloceles, these are not covered by a peritoneal layer and are exposed to amniotic fluid.

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