Gastroschisis

Gastroschisis is a displacement of the intestines through a defect on the side of the umbilical cord, usually the right side. Babies are born with this condition, and no one knows why. During development in the womb, it is normal for the intestines to develop outside of the baby’s abdomen at first, but usually they go inside and stay inside. In gastroschisis, the muscles in the abdomen are weak, and this allows the intestines to bulge through. When a baby is born with this condition, the intestines all are exposed on the abdomen. Because the intestines were exposed to amniotic fluids and other things during birth, sometimes they are damaged when the baby is born. Very few other birth defects are associated with gastroschisis.

Surgery is needed to correct this condition. With the baby under general anesthesia, the surgeon makes an incision to enlarge the hole where the intestines protrude. The intestines are examined closely for damage. Damaged or defective tissue is removed, and the healthy edges are stitched together. A tube is inserted into the stomach (a gastrostomy tube or G-tube) and out through the skin. The organs are replaced in the abdominal cavity, and the incision is closed, if possible. If the abdomen is too small or the organs are too swollen to allow the skin to be closed, a pouch is made from a sheet of plastic to cover and protect the organs. Complete closure may be accomplished over a few weeks. Surgery may be needed to repair the abdominal muscles later, and the infant’s abdomen may be smaller than normal.

Placing the organs back into the cavity can cause breathing difficulties. The infant may require a breathing tube and ventilator for a few days or weeks until the swelling goes down and the size of the abdomen has increased.

After surgery, the baby will be taken to an intensive care unit and placed in an incubator to keep him or her warm and prevent infection. The baby will be given oxygen, intravenous fluids, antibiotics and pain medication. A nasogastric tube will be placed to rest the stomach. The nurses will start feeding through this tube as soon as bowel functioning starts. Feedings are started very slowly, and babies sometimes are not willing to eat. They need lots of patience and encouragement.

For an appointment with a Washington University pediatric surgeon, call (314) 454-6022, Monday-Friday, 8 a.m.-5 p.m.