Congenital GI - Gastroschisis, Exomphalos

Question 1

Gastroschisis
-what is it
-risk factors
-presentation
-management

Answer 1

Abdominal wall defect - does not fully form so intestines develop outside
-R lateral to umbilicus

Maternal U20
Smokes, alcohol

Detected on prenatal US or on delivery
Can try vaginal delivery

Place intestines in special plastic bag to reduce water and heat loss
NG drainage, IV feeds
Surgery within 4 hrs

Question 2

Exomphalos
-what is it
-associations
-presentation
-management

Answer 2

Gut forms outside body but is not reabsorbed
-covered by anterior abdominal wall

Association with Downs, cardiac, kidney malformations

Detected on prenatal US or on delivery
CS to reduce risk of sac rupture

If primary closure surgery not possible => staged repair
-sac allowed to granulate and epithelialize over, forming shell - weeks/months
-once abdominal cavity large enough, remove shell and close abdomen