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Fetal Development and Maternal Diet
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Gastroschisis is a full-thickness abdominal wall defect located to the right of the umbilical cord insertion. Bowel herniates through the defect into the amniotic cavity. Gastroschisis is an isolated defect that is more common in infants of younger mothers and does not involve other organ systems. Coexisting bowel abnormalities such as jejunal atresia are found in approximately 15% of cases. Fetal growth restriction complicates gastroschisis in 15%–40% of cases. See Chapter 17 for the nutrition management of patients with gastroschisis.
Gastroschisis
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Marshall Z. Schwartz, Shaheen J. Timmapuri
Gastroschisis is an anterior abdominal wall defect that occurs in utero, through which there is herniation of intra-abdominal viscera into the amniotic sac. It is thought to result from a defect at the site of involution of the second (right) umbilical vein. This anomaly is accompanied by non-rotation of the bowel and an increased incidence of intestinal abnormalities, including atresia, perforation, and infarction, resulting from midgut volvulus or vascular thrombosis. The incidence of gastroschisis is approximately 1 in 4000–6000 live births.
Fetal Structural Malformations and Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Howard J.A. Carp, Thomas Philipp, Micha Baum, Michal Berkenstadt
Trunk defects include spina bifida, omphalocele, and gastroschisis. The phenotype of spina bifida is different in the embryo than in the fetus or neonate. In the embryo, spina bifida is frequently observed as a plaque-like protrusion of neural tissue over the caudal spine [14]. The physiological midgut herniation is a macroscopically visible process which starts in the 6th week after fertilization. The midgut only fully returns to the abdominal cavity at the end of 10 weeks of development. As herniation is still physiological at 8 developmental weeks, omphalocele can only be diagnosed in the fetal period. Gastroschisis differs from the physiological herniation of the midgut as the umbilical cord is not involved and no sac is present. Gastroschisis is rarely observed in the embryo. The pathogenesis of gastroschisis is controversial. The theory of abdominal wall disruption as a result of an “in utero” vascular accident has gained the most acceptance. Therefore, gastroschisis is considered to be a sporadic event with a negligible risk of recurrence.
Acute acalculous cholecystitis in an infant after gastroschisis closure
Published in Baylor University Medical Center Proceedings, 2023
Irfan Shehzad, Nicholas Nelson, Niraj Vora, Hale Wills, Krista Birkemeier, Vinayak Govande
Gastroschisis is a congenital defect of the full-thickness periumbilical abdominal wall in which abdominal contents do not return appropriately to the abdomen during embryological development, usually associated with evisceration of bowel and sometimes other abdominal organs. Advances in perinatal care, closure techniques, and postoperative parenteral and enteral nutritional support contribute to a survival rate above 90%, even in cases of complicated gastroschisis.1,2 Congenital anomalies and postsurgical complications of the biliary system are extremely rare in patients with gastroschisis. Choledochal cyst,3 gallbladder atresia, biliary atresia,4 gallbladder evisceration,5 choledocholithiasis in an adolescent with gastroschisis closure as neonate, cholestasis, and biliary obstruction in infants who had undergone gastroschisis closure have been reported.6,7 To our knowledge, there have been no reports of acalculous cholecystitis. Herein, we report a case of acute perforated acalculous cholecystitis in an infant who had undergone gastroschisis closure.
Gestational Outcomes of Pregnancies with Prenatally Detected Gastroschisis and Omphalocele
Published in Fetal and Pediatric Pathology, 2019
Fatih Aktoz, Ozgur Ozyuncu, Atakan Tanacan, Erdem Fadiloglu, Canan Unal, Tutku Soyer, Tolga Celik, Mehmet Sinan Beksac
Gastroschisis was defined as the presence of a paraumbilical abdominal wall defect, usually to the right of the midline, with visceral herniation on ultrasound examination. The umbilical cord insertion site adjacent to the defect was normal. The intestines floated freely in the amniotic fluid without a covering membrane. Omphalocele was defined as an upper, middle, or lower midline abdominal wall defect covered by an outer membrane of amnion and an inner membrane of peritoneum containing abdominal contents on ultrasound examination [3, 4]. All omphalocele cases were evaluated in terms of associated syndromes like Pentalogy of Cantrell, amniotic band sequence, schisis association, OEIS syndrome (omphalocele, exstrophy of the bladder, imperforate anus, spinal defects), Shprintzen syndrome, Carpenter syndrome, Goltz syndrome, Marshall-Smith syndrome, Meckel-Gruber syndrome, otopalato-digital type II syndrome, CHARGE (coloboma, heart defect, atresia choanae, restricted growth and development, genital abnormality, and ear abnormality) syndrome, and Beckwith-Wiedemann syndrome (macroglossia, gigantism, omphalocele) [14–16]. A detailed ultrasound examination was performed in order to detect coexisting abnormalities and all cases were evaluated by medical genetics. Suspicious findings for a fetal abdominal wall defect was recorded during the first trimester ultrasound scan of all the cases. However, final diagnosis was confirmed by detailed fetal abnormality screening performed between the 18th and 22nd gestational weeks by an expert perinatologist.
A case of penile duplication with neonatal teratoma and bladder neck incompetence
Published in Scandinavian Journal of Urology, 2021
Martin Skott, Ulrik Korsgaard, Yazan F. Rawashdeh
An 8-year-old boy was referred to our Department with urinary incontinence for evaluation of a genital anomaly. Antenatal, gastroschisis was suspected at the routine antenatal ultrasound scans, but was subsequently ruled out by fetal MRI. A large ventral hernia of the lower abdomen was however noted. At birth physical examination revealed a bifid scrotum, a redundant prepuce and a large 20 × 30 × 40 mm skin covered tumour in the region between the scrotum and penis. An MRI scan of the lower abdomen showed bilateral descended testes and a heterogeneous mass adjacent to the right testis, without connection to the peritoneal cavity, but with an extension to the perineum.