|Year : 2012 | Volume
| Issue : 3 | Page : 177-178
Padmavathi Devi Chaganti, Bharat Rao Natta, Usha Bhargavi Emani, Zahid Akifa, Sravani Ponnada, Sasank Ramanavarapu
Department of Pathology, Gout Siddartha Medical College, Vijayawada, Andhra Pradesh, India
|Date of Web Publication||15-Oct-2012|
Padmavathi Devi Chaganti
Gout Siddartha Medical College, Vijayawada, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Gastroschisis is a rare congenital abdominal wall defect that requires prompt surgical correction. It almost exclusively occurs in infants of mothers younger than 25 years of age. The overall incidence of gastroschisis is 1 in 10,000 live births. It is characterized by normal umbilical cord insertion with defect being extra-abdominal through which abdominal contents protrude. There is no covering sac and the size of the defect is less than 4 cm. Here, we report a case of gastroschisis occurring in a 22-year-old female.
Keywords: Extra-umbilical defect, gastroschisis, omphalocele
|How to cite this article:|
Chaganti PD, Natta BR, Emani UB, Akifa Z, Ponnada S, Ramanavarapu S. Gastroschisis. J NTR Univ Health Sci 2012;1:177-8
| Introduction|| |
Gastroschisis and omphalocele are anterior abdominal wall defects; the incidence being 1 in 10,000 births for gastroschisis and 2.5 in 10,000 births for omphalocele.  Cases of gastroschisis are grouped along with prune belly and exomphalos in the anomalies of abdominal wall, whereas omphalocele was included under diseases of digestive tract.
| Case Report|| |
A 22-year-old female with a bad obstetric history attended obstetrics department with spontaneous abortion. She was gravida 3 and para 3 at the time of presentation. The first pregnancy was terminated for anencephaly. The second pregnancy was a spontaneous abortion at 12 weeks.
The present pregnancy also was a spontaneous abortion at 20 weeks. There is no history of ultrasound examination in the antenatal period.
We received a male fetus weighing 150 gm without placenta. The crown rump length was 12 cm and head circumference was 10 cm. The fetus was small for dates.
External examination showed a 3 cm defect in the anterior abdominal wall to the right of the umbilicus with loops of intestine coming out of the defect. There was no covering sac [Figure 1] and [Figure 2] and umbilicus was normal. There were no other external or internal abnormalities. There was no history of consanguinity, usage of alcohol, smoking or usage of drugs. Other family members were normal as well.
|Figure 1: Showing defect on the right side with intact anterior abdominal wall near umbilicus|
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|Figure 2: Close up of intestinal loops coming out of abdominal wall defect|
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| Discussion|| |
Gastroschisis is a rare congenital abnormality and is attributable to defect in differentiation of somatopleural mesenchyme.  Gastroschisis occurs when there is a premature atrophy or abnormal persistence of right umbilical vein.  The incidence of gastroschisis has increased from 0.03% to 0.1% since 1980.  It usually occurs between 5 th and 10 th week of gestation. In few cases, it occurred after 33 weeks of gestation.  Gastroschisis has to be differentiated from omphalocele based on the location, size of the defect, presence of sac, type and frequency of anomalies.  In gastroschisis the size of the defect is less than 4 cm, extra-umbilical to the right of umbilicus sac was never present, and the bowel is usually matted. In addition to bowel, stomach, urinary bladder, uterus and adnexa can be extruded through the defect.  Incidence of gastroschisis is highest among mothers younger than 20 years of age and it declines steeply with increasing age.  It is observed that familial occurrence of gastroschisis is reported and there is a history of recurrence in patients where there is a positive family history.  Associated anomalies occur in 5% to 24% of gastroschisis. Total 22% of infants with isolated gastroschisis are born prematurely  and the birth weight is less than 2500 gm in 38%.  Fetal gastroschisis is diagnosed by ultrasonography. 
When catamnestic investigations were performed in children with malformations of gastrointestinal tract, it is observed that anorectal fistula has the highest incidence of 27% and gastroschisis has the lowest incidence that is 8%.  The increased rate of gastroschisis is due to enhanced awareness on the part of pediatricians. The cases that were diagnosed as omphalocele previously are now reclassified as gastroschisis. Gastroschisis is suspected to be caused by alcohol, X-rays and drugs during pregnancy but it has no relation to smoking. When a study was conducted comparing the characteristics of survivors and non-survivors in cases of gastroschisis, it is observed that the mode of delivery, type of closure, birth weight and gestational age do not have any significance in the prognosis of this disorder. Presence of another major anomaly or development of enterocolitis adversely affects the prognosis.
| References|| |
|1.||Torfs C, Curry C, Roeper P. Gastroschisis. J Paediatr 1990;116:1-5. |
|2.||Hwang PJ, Kousseff BG. Omphalocele and gastroschisis: An 18-year review study. Genet Med 2004;6:232-6. |
|3.||Mercer S, Merser B, Alton D, Soucy P. Gastroschisis: Ultrasonographic diagnosis, perinatal embryology, surgical and obstetric treatment and outcomes. Can J Surg 1988;31:25-6. |
|4.||Bugge M, Hauge M. Gastroschisis ogomphalocele I Danmark. Ugeskr Laeger 1983;145:1323-7. |
|5.||Salinas CF, Bartoshesky L, Othersen HB Jr, Leape L, Feingold M, Jorgenson RJ. Familial occurrence of gastroschisis four new cases and review of literature. Am J Dis Child 1979;133:514-7. |
|6.||Eggink BH, Richardson CJ, Malloy MH, Angel CA. Outcome of gastroschosis: A 20 year case review of imfants with gastroschisis born in Galveston. Texas J Pediatr Surg 2006;41:1103-8. |
|7.||Knott PD, Colley NV. Can fetal gastroschisis always be diagnosedprenatally? Prenat Diagn 1987:7:607-10. |
|8.||Angerpointer T, Radtke W, Murken JD. Catamnestic investigations in children with malformations of gastrointestinal tract and the abdominal wall. Z Kinderchir 1981;32:129-441. |
[Figure 1], [Figure 2]