Abdominal Wall Defects

Chapter 6

Abstract

1. Introduction

associated anomalies [1–3].

term problems are rare [9].

2. Etiology and embryology

complications.

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Management of Gastroschisis

fluid management and possible complications are discussed.

Keywords: gastroschisis, AWDs, fluid management, LMIC, complications

Gastroschisis (GS) or more aptly "laparoschisis" is a congenital abdominal wall defect (AWD) leading to herniation of the gut more commonly to the right of the umbilical cord (Figure 1). It differs from other AWDs in causality, risk factors, and

GS incidence is increasing worldwide [4, 5] and is estimated around 1 in 2200 live births [6, 7]. Antenatal scans detect most cases [8], survival in developed countries is excellent [7] and apart from some gastrointestinal dysfunction, long-

This chapter is dedicated to discuss in simplified flowchart-form the initial, operative and post-operative management of GS with emphasis on low-resource settings. In addition it aims to outline salient topics such as fluid management and

Though unexplained, a young maternal age and low socioeconomic status are the commonest risk factors for GS [10, 11]. Smoking, drugs, environmental toxins and poor nutrition have also been implicated [12]. A genetic link in the form of homozygous gene polymorphisms has been reported [13] and is substantiated by an increased prevalence among familial cases of birth defects and twins [14].

The embryological origin of GS is still a matter of conjecture. Several theories have been put forward attempting to expound the abdominal wall defect: failed body-wall folding [15]; a vascular insult to the omphalo-mesenteric artery [16] or to the right umbilical vein [17]; a localized disruption of the amniotic membrane [18]

Gastroschisis (GS) is one of the congenital abdominal wall defects, in which the bowel has prolapsed without a covering through a defect adjacent to (and nearly always to the right of) an otherwise normal umbilicus. Proper management of such cases gives them the opportunity to survive and thrive. In this chapter, simplified flowcharts for the initial management of GS, surgical intra-operative decisions and post-operative active follow-up of such cases will be presented and discussed. The first flowchart will discuss how to deal with a GS case from birth till the operative theatre, while the second flowchart will take the lead to guide the surgeon with the available surgical options and how to choose the suitable one for the case. Finally, the post-operative active follow-up

Alaa Obeida and Aly Shalaby
