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Castro PT, Matos APP, Macedo N, Ribeiro G, Lopes J, Dittmer FP, Araujo Júnior E, Werner H. Prenatal diagnosis of closed gastroschisis: What to expect in the most severe form of gastroschisis? Case report and literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1356-1363. [PMID: 37596943 DOI: 10.1002/jcu.23543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/21/2023]
Abstract
Closed gastroschisis (CG) and vanishing gastroschisis (VG) are the most severe forms of evolution of the malformation. In this case, a fetus presented with gastroschisis at 13 weeks, and the gastroschisis was not visualized at 22 weeks of gestation. Distal ileum, cecum, and ascending colon atresia were diagnosed at surgery, and the child is fully enteral-fed at 5 months of age. In a literature review of 43 cases of prenatal diagnosis of CS-VG, intrauterine death occurred in 4.5% of cases. 79.6% of the cases underwent surgical treatment. Of these cases, 20% of cases died due to complications of treatment, 26% were still under treatment and 54% are alive with enteral feeding. In 77% of the cases, the closure of the umbilical ring occurred after 26 weeks of gestation and the absence of prenatal diagnosis of CG-VG during pregnancy has a risk of 71% of death.
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Affiliation(s)
- Pedro Teixeira Castro
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
| | - Ana Paula Pinho Matos
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
| | - Nicanor Macedo
- Department of Surgery, Gaffrè and Guinle University Hospital, Rio de Janeiro, Brazil
| | | | - Jorge Lopes
- Biodesign Laboratory DASA / PUC, Rio de Janeiro, Brazil
| | - Fernanda Parciasepe Dittmer
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Medical Course, Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
- Biodesign Laboratory DASA / PUC, Rio de Janeiro, Brazil
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Granger J, Do-Wyeld M, Cundy TP, Galek A, Stark MJ, Cord-Udy CL. Regional cluster of vanishing gastroschisis: A comparative study of antenatal and post-natal outcomes. J Paediatr Child Health 2020; 56:420-425. [PMID: 31614068 DOI: 10.1111/jpc.14644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/07/2019] [Accepted: 09/10/2019] [Indexed: 11/27/2022]
Abstract
AIM Vanishing gastroschisis describes the in utero spontaneous closure of the periumbilical defect. It is usually associated with intestinal loss due to ischaemia, necrosis and atresia. This comparative study aims to investigate the spectrum of pathology, antenatal ultrasound characteristics and post-natal outcomes. METHODS Our tertiary centre provides antenatal and post-natal care of major congenital anomalies for a population of 1.6 million. Medical records were retrospectively evaluated for all cases of vanishing gastroschisis from May 2014 to May 2015. Cases of normal variant gastroschisis born during the same period were used for comparison. Maximum antenatael bowel diameter measurements were compared using the Mann-Whitney U-test. RESULTS Six infants with vanishing gastroschisis were born during the study period, representing 50% of all live-born gastroschisis. Antenatal ultrasound showed progressively increasing intra-abdominal bowel dilatation, with antenatal intra-abdominal bowel diameter significantly greater in vanishing, than normal, variant gastroschisis (23.2 vs. 4.1 mm, P < 0.01). The classification of vanishing gastroschisis severity comprised two type I, three type II and one type III cases. Complete midgut atresia affected three infants, leading to overall mortality of 50% for the vanishing gastroschisis group versus 0% in the normal variant group (P = 0.05). CONCLUSION Vanishing gastroschisis is a severe, often catastrophic variant of gastroschisis. Aetiological factors contributing to the recent high incidence of this rare complication in our population of newborns remain unknown, prompting secondary prevention strategies to salvage the midgut. We propose closer antenatal surveillance for fetuses with intra-abdominal bowel dilatation >10 mm to prompt consideration of earlier delivery to improve morbidity and mortality.
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Affiliation(s)
- Jeremy Granger
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Montgommery Do-Wyeld
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Thomas P Cundy
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Alison Galek
- Division of Medical Imaging, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Michael J Stark
- Department of Neonatology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Catherine L Cord-Udy
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Vanishing Gastroschisis with a Favorable Outcome after a 3-Year Follow-Up: A Case Report and Literature Review. Case Rep Obstet Gynecol 2020; 2020:8542087. [PMID: 31970004 PMCID: PMC6969982 DOI: 10.1155/2020/8542087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/23/2019] [Indexed: 01/14/2023] Open
Abstract
Vanishing gastroschisis (VG) is a severe complication of gastroschisis with a high mortality rate. We report here a case of VG with a favorable outcome after a 3-year follow-up. A 26-year-old primigravida woman was referred to Strasbourg University Hospital because her fetus was diagnosed with an isolated gastroschisis at 13-week gestation. The ultrasound evolution was marked by a progressive closure of the abdominal wall defect from 19-week gestation and the appearance of dilated intra-abdominal loops. The child was born with a closed abdominal wall except a small remnant at the level of the former gastroschisis orifice. Explorative laparotomy revealed extensive midgut atresia with only 50 cm of remaining midgut. A jejunocolic anastomosis was performed. The child is now 3 years old and has a favorable outcome with only 2 nights a week of parenteral nutrition. A total of 39 cases of VG type D from Perrone et al. classification are described in the literature from 1991 to 2019, among which 19 (48.7%) are alive at the time of publication but only 4 cases are described with a long-term follow-up of 3 years or more. This is the fifth case described with a favorable evolution after 3-year follow-up.
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Abstract
PURPOSE The diagnosis of "closing" or "closed gastroschisis" is made when bowel is incarcerated within a closed or nearly closed ring of fascia, usually with associated bowel atresia. It has been described as having a high morbidity and mortality. METHODS A retrospective review of closing gastroschisis cases (n = 53) at six children's hospitals between 2000 and 2016 was completed after IRB approval. RESULTS A new classification system for this disease was developed to represent the spectrum of the disease: Type A (15%): ischemic bowel that is constricted at the ring but without atresia; Type B (51%): intestinal atresia with a mass of ischemic, but viable, external bowel (owing to constriction at the ring); Type C (26%): closing ring with nonviable external bowel +/- atresia; and Type D (8%): completely closed defect with either a nubbin of exposed tissue or no external bowel. Overall, 87% of infants survived, and long-term data are provided for each type. CONCLUSIONS This new classification system better captures the spectrum of disease and describes the expected long-term results for counseling. Unless the external bowel in a closing gastroschisis is clearly necrotic, it should be reduced and evaluated later. Survival was found to be much better than previously reported. TYPE OF STUDY Retrospective case series with no comparison group. LEVEL OF EVIDENCE Level IV.
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Vanishing gastroschisis visualized by antenatal ultrasound: a case report and review of literature. Eur J Obstet Gynecol Reprod Biol 2018; 228:186-190. [PMID: 29980113 DOI: 10.1016/j.ejogrb.2018.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/13/2018] [Indexed: 11/23/2022]
Abstract
We report a case of vanishing gastroschisis visualized by antenatal ultrasound with a 7-year long term follow-up. Currently, the child is still dependent on daily parenteral nutrition with no signs of hepatotoxicity. To our knowledge, it's the fourth case with a long-term follow-up. Vanishing gastroschisis is a rare complication of gastroschisis. However, physicians should be aware of it because its prognosis is worse than classical gastroschisis. When a vanishing gastroschisis is visualized or suspected by antenatal ultrasound, prenatal counseling is required with explanations about the risk of short bowel syndrome, the need of parenteral nutrition and related complications (inflammatory colitis, sepsis, liver failure and organ transplant). Mortality rate was initially around 93%, and dropped to 27% after the years 2000 (versus 10% for classical gastroschisis). After birth, all children will require surgery, and sometimes autologous gastro-intestinal reconstruction. Most survivors (68%) could be taken off the TPN. Unfortunately, long-term outcomes for children with vanishing gastroschisis are still missing in current literature.
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Vanishing gastroschisis: Good outcome after a 10-year follow-up. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Geslin D, Clermidi P, Gatibelza ME, Boussion F, Saliou AH, Le Manac'h Dove G, Margaryan M, De Vries P, Sentilhes L, Levard G, Lardy H, Arnaud A, Leclair MD, Podevin G, Schmitt F. What prenatal ultrasound features are predictable of complex or vanishing gastroschisis? A retrospective study. Prenat Diagn 2017; 37:168-175. [DOI: 10.1002/pd.4984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/19/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Dorothée Geslin
- Paediatric Surgery Department; University Hospital of Angers; Angers France
- Paediatric Surgery Department; University Hospital of Lyon; Lyon France
| | - Pauline Clermidi
- Paediatric Surgery Department; University Hospital of Nantes; Nantes France
- Paediatric Surgery Department; Robert Debré University Hospital; Paris France
| | - Marie-Eve Gatibelza
- Paediatric Surgery Department; University Hospital of Poitiers; Poitiers France
- Paediatric Surgery Department; University Hospital of Rennes; Rennes France
| | - Françoise Boussion
- Department of Obstetrics and Gynecology; Angers University; Angers France
| | - Anne-Hélène Saliou
- Department of Obstetrics and Gynecology; University Hospital of Brest; Brest France
| | | | - Marc Margaryan
- Paediatric Surgery Department; Le Mans Hospital; Le Mans France
| | - Philine De Vries
- Paediatric Surgery Department; University Hospital of Brest; Brest France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology; University Hospital of Bordeaux; Bordeaux France
| | - Guillaume Levard
- Paediatric Surgery Department; University Hospital of Poitiers; Poitiers France
| | - Hubert Lardy
- Paediatric Surgery Department; University Hospital of Tours; Tours France
| | - Alexis Arnaud
- Paediatric Surgery Department; University Hospital of Rennes; Rennes France
| | - Marc-David Leclair
- Paediatric Surgery Department; University Hospital of Nantes; Nantes France
| | - Guillaume Podevin
- Paediatric Surgery Department; University Hospital of Angers; Angers France
| | - Françoise Schmitt
- Paediatric Surgery Department; University Hospital of Angers; Angers France
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Abstract
PURPOSE OF REVIEW The diagnosis and treatment of gastroschisis spans the perinatal disciplines of maternal fetal medicine, neonatology, and pediatric surgery. Since gastroschisis is one of the commonest and costliest structural birth defects treated in neonatal ICUs, a comprehensive review of its epidemiology, prenatal diagnosis, postnatal treatment, and short and long-term outcomes is both timely and relevant. RECENT FINDINGS The incidence of gastroschisis has increased dramatically over the past 20 years, leading to a renewed interest in causation. The widespread availability of maternal screening and ultrasound results in very high rates of prenatal diagnosis, which enables evaluation of the optimal timing and mode of delivery. The preferred method of surgical closure continues to be an issue of debate among pediatric surgeons, whereas postsurgical treatment seeks to expedite the initiation and progression of enteral feeding and minimize complications. A small subset of babies with complex gastroschisis leading to intestinal failure benefit from the knowledge and expertise of dedicated interdisciplinary teams, which seek to bring novel therapies and improved clinical outcomes. SUMMARY The opportunities to increase the knowledge of causation, and identify best practices leading to improved outcomes, drive the ongoing need for collaborative clinical research in gastroschisis.
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Fawkner-Corbett DW, Shepherd G, Lakhoo K. Emergency abdominal wall defects in neonates: saved by distress. BMJ Case Rep 2016; 2016:bcr-2016-214596. [PMID: 27030461 DOI: 10.1136/bcr-2016-214596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This report presents two cases of neonatal patients with abdominal wall defects requiring emergency intervention, a closing gastroschisis and a pedunculated exomphalos with eviscerated liver. Both presented as pre-partum fetal distress and were delivered in a tertiary centre, where they received antenatal care. Coordination in the multidisciplinary team and prompt surgical intervention prevented loss of the eviscerated abdominal contents and prevented mortality in both cases.
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Affiliation(s)
| | | | - Kokila Lakhoo
- Department of Paediatric surgery, John Radcliffe Hospital, Oxford, UK
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Carnaghan H, Pereira S, James CP, Charlesworth PB, Ghionzoli M, Mohamed E, Cross KMK, Kiely E, Patel S, Desai A, Nicolaides K, Curry JI, Ade-Ajayi N, De Coppi P, Davenport M, David AL, Pierro A, Eaton S. Is early delivery beneficial in gastroschisis? J Pediatr Surg 2014; 49:928-33; discussion 933. [PMID: 24888837 DOI: 10.1016/j.jpedsurg.2014.01.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Gastroschisis neonates have delayed time to full enteral feeds (ENT), possibly due to bowel exposure to amniotic fluid. We investigated whether delivery at <37weeks improves neonatal outcomes of gastroschisis and impact of intra/extra-abdominal bowel dilatation (IABD/EABD). METHODS A retrospective review of gastroschisis (1992-2012) linked fetal/neonatal data at 2 tertiary referral centers was performed. Primary outcomes were ENT and length of hospital stay (LOS). Data (median [range]) were analyzed using parametric/non-parametric tests, positive/negative predictive values, and regression analysis. RESULTS Two hundred forty-six patients were included. Thirty-two were complex (atresia/necrosis/perforation/stenosis). ENT (p<0.0001) and LOS (p<0.0001) were reduced with increasing gestational age. IABD persisted to last scan in 92 patients, 68 (74%) simple (intact/uncompromised bowel), 24 (26%) complex. IABD or EABD diameter in complex patients was not significantly greater than simple gastroschisis. Combined IABD/EABD was present in 22 patients (14 simple, 8 complex). When present at <30weeks, the positive predictive value for complex gastroschisis was 75%. Two patients with necrosis and one atresia had IABD and collapsed extra-abdominal bowel from <30weeks. CONCLUSION Early delivery is associated with prolonged ENT/LOS, suggesting elective delivery at <37weeks is not beneficial. Combined IABD/EABD or IABD/collapsed extra-abdominal bowel is suggestive of complex gastroschisis.
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Affiliation(s)
- Helen Carnaghan
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Susana Pereira
- The Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK
| | | | | | - Marco Ghionzoli
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Elkhouli Mohamed
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - Kate M K Cross
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Edward Kiely
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Shailesh Patel
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Ashish Desai
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Kypros Nicolaides
- The Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK
| | - Joseph I Curry
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Niyi Ade-Ajayi
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Paolo De Coppi
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Mark Davenport
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Anna L David
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simon Eaton
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
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Wood SJ, Samangaya RA, Gillham JC, Morabito A. Gastroschisis and the risk of short bowel syndrome: outcomes and counselling. Neonatology 2014; 105:5-8. [PMID: 24193105 DOI: 10.1159/000351038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/21/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gastroschisis can be associated with short bowel syndrome (SBS). We present 4 cases with significant bowel shortening with very different ante- and postnatal presentations. CASES Three of the cases demonstrated 'vanishing' gastroschisis with progressively worsening antenatal intra-abdominal bowel dilatation with no defect present at birth. The fourth case followed an uneventful course antenatally but developed SBS considered secondary to gastroschisis-related atresia and necrosis. All 4 cases were classified as having SBS and were enrolled within the paediatric Intestinal Rehabilitation Programme. This involves autologous gastrointestinal reconstruction following a period of bowel expansion with concomitant parenteral and enteral nutrition. DISCUSSION These cases demonstrate that the serious complication of significant bowel loss cannot always be anticipated. Early multidisciplinary discussion with the parents enables a shared understanding of potential outcomes. It can aid the recognition of 'vanishing' gastroschisis enabling expedient investigations and early intervention, minimising morbidity and maximising bowel length.
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Affiliation(s)
- Sarah J Wood
- Royal Manchester Children's Hospital, Manchester, UK
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12
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Brugger PC, Prayer D. Development of gastroschisis as seen by magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:463-470. [PMID: 21105024 DOI: 10.1002/uog.8894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/29/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To describe the magnetic resonance imaging (MRI) morphology and fetal development of gastroschisis. METHODS Twenty-seven fetal MRI studies of 24 fetuses (mean gestational age 30 (range, 21-38) weeks), with gastroschisis were retrospectively analyzed. The extra- and intra-abdominal positions of the abdominal organs were assessed on T1- and T2-weighted and steady-state free-precession sequences with emphasis on the intra-abdominal findings. RESULTS Third-trimester fetuses (n = 16) showed a uniform morphology: the extracorporeal bowel included jejunum, ileum and colon except for parts of the sigmoid and the rectum. Intra-abdominally the stomach was in contact with the left-sided urinary bladder in 15 of these. Second-trimester fetuses (n = 8) differed with respect to the amount of intra-abdominal bowel and had longer sections of the colon and jejunum intra-abdominally. Intrauterine follow-up (n = 3) demonstrated exteriorization of these bowel segments. Three third-trimester fetuses with gastroschisis complicated by small bowel obstruction, in addition to the dilated small bowel loops, had variable lengths of intra-abdominal colon. CONCLUSIONS Fetal development of gastroschisis is a dynamic process lasting until birth. The typical morphology of gastroschisis changes from the second to the third trimester, since intra-abdominal bowel becomes eventrated by the end of the second trimester. This process of eventration is stopped in cases of intestinal stenosis/atresia caused by narrowing of the abdominal wall defect, resulting in different lengths of intra-abdominal bowel. The time when this occurs may correlate with the amount of viable bowel in cases of intestinal atresia. The concept presented here explains the findings in closing gastroschisis.
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Affiliation(s)
- P C Brugger
- Centre for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
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Khalil BA, Gillham JC, Foresythe L, Harding R, Johnston T, Wright C, Morabito A. Successful management of short gut due to vanishing gastroschisis - case report and review of the literature. Ann R Coll Surg Engl 2010; 92:W10-3. [PMID: 20529453 PMCID: PMC5696947 DOI: 10.1308/147870810x12659688852437] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2010] [Indexed: 11/22/2022] Open
Abstract
Vanishing gastroschisis is a rare in utero complication of gastroschisis. It is associated with a high mortality. We present a case report of an infant with vanishing gastroschisis that was managed with a combination of reconstructive bowel surgery and hepatosparing parenteral nutrition. The technique is described and a review of the literature is provided.
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Affiliation(s)
- B A Khalil
- Department of Obstetrics, St Mary's Hospital for Women, Manchester, UK.
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15
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Saxonhouse MA, Kays DW, Burchfield DJ, Hoover R, Islam S. Gastroschisis with jejunal and colonic atresia, and isolated colonic atresia in dichorionic, diamniotic twins. Pediatr Surg Int 2009; 25:437-9. [PMID: 19308430 DOI: 10.1007/s00383-009-2353-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2009] [Indexed: 10/21/2022]
Abstract
Despite the increasing incidence of gastroschisis, the cause remains unknown. Genetic factors may contribute to bowel anomalies as demonstrated by cases of gastroschisis in twins and siblings, and other types of bowel anomalies in twins. Atresia of the colon represents one of the rarest causes of neonatal intestinal obstruction. We present the first case of dichorionic, diamniotic male twins in which there was gastroschisis with jejunal and colonic atresia in Twin A and isolated colonic atresia in Twin B.
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Affiliation(s)
- Matthew A Saxonhouse
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, P.O. Box 100296, Gainesville, FL 32610-0296, USA.
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Houben C, Davenport M, Ade-Ajayi N, Flack N, Patel S. Closing gastroschisis: diagnosis, management, and outcomes. J Pediatr Surg 2009; 44:343-7. [PMID: 19231531 DOI: 10.1016/j.jpedsurg.2008.10.084] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 10/23/2008] [Indexed: 12/16/2022]
Abstract
PURPOSE Gastroschisis (GS) is defined as a full-thickness abdominal wall defect (usually right-sided) with intestinal prolapse and occasionally other viscera. The defect itself may close around the viscera causing exit or entry level intestinal atresia and ischaemia or midgut infarction, previously described as closed GS. We now report the largest series of infants born with various stages of closing GS describing features, management, and outcome. METHODS The study used a single-centre retrospective review of infants with GS and evidence of defect closure at birth. RESULTS Nine infants (6 girls) with a median of 35 (range, 32-36) weeks of gestation fulfilled criteria for closing GS from a series of 146 (6%) infants born from August 1994 to December 2007. Delivery had been expedited in 6 based on increasing intraabdominal bowel dilatation and suspicion of closing GS on serial antenatal ultrasound. At delivery, 5 had compromised but viable bowel and required intestinal surgery. Three fetuses, all with midgut necrosis, had antenatal scans typical of GS with no additional features. After a variety of surgical procedures, 7 patients are now fully enterally fed, one is parenteral nutrition-dependent. One died of end-stage liver failure secondary to short bowel syndrome. The length of follow-up was 6 (range, 0.5-11) years. CONCLUSIONS Of infants with GS, 6% present with closing abdominal ring. Close antenatal monitoring may prevent severe bowel loss in some cases. After multiple surgical interventions, most have a favorable outcome.
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Affiliation(s)
- Chris Houben
- Department of Paediatric Surgery, King's College Hospital, London, United Kingdom.
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Estrada JJ, Petrosyan M, Hunter CJ, Lee SL, Anselmo DM, Grikscheit TC, Stein JE, Wang KS, Ford HR, Shaul DB. Preservation of extracorporeal tissue in closing gastroschisis augments intestinal length. J Pediatr Surg 2008; 43:2213-5. [PMID: 19040937 DOI: 10.1016/j.jpedsurg.2008.08.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 08/29/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prenatal closure of the umbilical ring in gastroschisis may result in an amorphous, nonviable appearing extracorporeal tissue that is resected during the repair. However, it is unclear whether such remnant intestine is truly nonviable. METHODS AND RESULTS We examined the outcomes of patients when this tissue is preserved. We identified 8 patients who presented with a closing gastroschisis and a mass of tissue connected by a vascular pedicle. Four patients underwent abdominal exploration with resection of the mass and gastroschisis closure. Histologic examination revealed normal intestinal wall architecture. All patients in this group developed short bowel syndrome, requiring long-term parenteral nutrition. Conversely, 4 patients underwent abdominal exploration with internalization of the remnant tissue, a maneuver referred to as "parking," along with either silo placement, or primary closure of the gastroschisis. At re-exploration, 3 of 4 patients were found to have viable intestine, and bowel continuity was reestablished. The mean parenteral nutrition requirement for this group was significantly shorter than the resected group. CONCLUSION In this series, we show that this amorphous tissue, when preserved, may exhibit normal intestinal architecture and absorptive function. Therefore, such remnant tissue should be preserved as it may significantly increase bowel length and minimize parenteral nutrition requirement.
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Affiliation(s)
- Joaquin J Estrada
- Division of Pediatric Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Childrens Hospital Los Angeles, CA 90027, USA
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Marven S, Owen A. Contemporary postnatal surgical management strategies for congenital abdominal wall defects. Semin Pediatr Surg 2008; 17:222-35. [PMID: 19019291 DOI: 10.1053/j.sempedsurg.2008.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Early definitive closure of abdominal wall defects is possible in most cases. Staged reduction does offer distinct advantages, and mortality and morbidity may be better. Risk stratification may produce outcome and tailor management of difficult cases in the form of a clinical pathway. Stem cell technology may, in the future, offer the ideal allogenic prosthesis in complex cases.
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Affiliation(s)
- Sean Marven
- Sheffield Children's Hospital NHS Foundation Trust, Western Bank, United Kingdom.
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Feldkamp ML, Carey JC, Sadler TW. Development of gastroschisis: review of hypotheses, a novel hypothesis, and implications for research. Am J Med Genet A 2007; 143A:639-52. [PMID: 17230493 DOI: 10.1002/ajmg.a.31578] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gastroschisis, a ventral body wall defect, is a continuing challenge and concern to researchers, clinicians, and epidemiologists seeking to identify its cause(s) and pathogenesis. Concern has been renewed in recent years because, unlike most other birth defects, rates of gastroschisis are reportedly increasing in many developed and developing countries. No tenable explanation or specific causes have been identified for this trend. Rates of gastroschisis are particularly high among pregnancies of very young women. Such an intriguing association, not observed to this degree with other birth defects, may afford clues to the defect's cause. Understanding the causes of gastroschisis may provide insight to the defect's origin. In pursuing such causal studies, it would be helpful to understand the embryogenesis of gastroschisis. To date, four main embryologic hypotheses have been proposed: (1) Failure of mesoderm to form in the body wall; (2) Rupture of the amnion around the umbilical ring with subsequent herniation of bowel; (3) Abnormal involution of the right umbilical vein leading to weakening of the body wall and gut herniation; and (4) Disruption of the right vitelline (yolk sac) artery with subsequent body wall damage and gut herniation. Although based on embryological phenomena, these hypotheses do not provide an adequate explanation for how gastroschisis would occur. Therefore, we propose an alternative hypothesis, based on well described embryonic events. Specifically, we propose that abnormal folding of the body wall results in a ventral body wall defect through which the gut herniates, leading to the clinical presentation of gastroschisis. This hypothesis potentially explains the origin of gastroschisis as well as that of other developmental defects of the ventral wall.
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Affiliation(s)
- Marcia L Feldkamp
- Department of Pediatrics, Division of Medical Genetics, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA.
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