The fetal gastroshisis in newborns: causes, diagnosis and treatment

The fetal gastroshisis is a serious pathology of newborns, in which the intestines and other organs are protruding through the hole in the peritoneum.

Content

Gastrochizis belongs to the group of congenital defects of the anterior abdominal wall in babies. For reasons that have not been fully studied, the abdominal wall does not close properly during intrauterine development. Through the hole in the navel area, the abdominal cavity comes out of the peritoneum - most often these are fragments of the intestine.

Read on our website another article on the topic: "Fruit hypoxia: symptoms and signs". You will learn about the consequences of fetal hypoxia for the child, as well as the treatment of fetal hypoxia.

Gastrochizis - A serious drawback, however, thanks to prenatal diagnosis and constantly improved treatment methods, the prognosis for small patients with this pathology has improved significantly over the years. From this article you will learn about the gastrochizis, as well as what complications can accompany the pathology, and how to treat it. Read further.

What kind of gastroshisis vice is open, closed in newborn children: the difference from omfalocele in infants

The gastroshizis is open, that is, the displacement of the intestinal organs, etc. For the abdominal cavity - a vice with a rather typical clinical picture for newborn children. The hole in the anterior abdominal wall of infants in most cases is to the right of the navel, in the immediate vicinity of it. The diameter of this hole does not exceed a few centimeters, so fragments of intestinal are usually bulging of various lengths. Brah of other organs from the abdominal cavity (for example, stomach or liver) is much less common.

It often happens that in the newborn, in addition to the loss of intestines, there is also an innate umbilical hernia - omfalocele. In another way, it is also called closed gastrochisis. There are typical features to distinguish these two shortcomings:

In the case of a hernia, the organs overlooking the abdomen are always surrounded by a special hernia bag.
With a gastrochisis outside the abdomen, we see a “bare” intestine, devoid of any shell.
A defect in the abdominal wall with a hernia can reach significant sizes. Herbies are often associated with other congenital defects, which can also be genetic.
Gastrochizis, in turn, is most often a separate (specific) defect.

The main problem of gastrochisis is not only that the intestines are outside the abdominal cavity, since it can usually be placed in the right place during the operation. A much more important role is played by how the intestines function outside its physiological location. Read further.

Gastrochisis: risk factors

As mentioned above, with a gastrochisis (unlike a hernia) there is no fabric or a layer insulating the intestines from the external environment. Thus, this body is in direct contact with amniotic fluid inside the uterus, This has an annoying effect on him. Intestinal tissues usually respond to such irritation by inflammation of varying severity. This is manifested by swelling and hardening the walls of the intestines.

Another important factor is blood supply of the protruding intestine. In a situation where the hole in the abdominal wall has a small diameter and is gradually delayed, local pressure on the vessels may occur. As a result, blood circulation is disturbed. Such a process in the scientific literature is called "Closing of the gastrochizis". In the absence of timely intervention, prolonged intestinal ischemia can lead to segmental necrosis or death of tissues.

Gastrochisis: Reasons

Despite the long -term clinical observations, the cause of the abnormal development of the anterior abdominal wall leading to the gastroshizis has not yet been established. At the stage of embryonic development, blood supply to cells or their movement can be impaired. However, the course of these processes has not been fully studied, so the methods of preventing gastrochizis are unknown.

The only confirmed supervision is the fact that the protrusion of the intestines more often occurs in children of very young mothers (13-16 years old). The role of factors of poor environment and the wrong lifestyle of the future mother (alcohol, cigarettes) is also increasingly emphasizing. Gastroshisis is rarely a genetic defect.

Gastrochizis: differential diagnosis, photo ultrasound

Today, the vast majority of gastroshisis cases are diagnosed during prenatal examinations.
The most important is ultrasound (ultrasound) in the second trimester. A typical picture of ultrasound examination with exfoliation is an amniotic intestine, slowly floating in the cavity, not covered with a hernial bag.

Here is a photo of the fetus with a similar defect on the ultrasound:

Differential prenatal diagnosis of gastrochisis is an indication for a pregnant patient for more frequent control ultrasound studies. It is necessary to constantly monitor the state of the dropped teems - whether there is inflammation, whether there is no obstruction, ischemia or necrosis of the wall.

It is worth knowing: The appearance of inflammation and a significant deterioration in the state of the intestine can be an indication for an earlier termination of pregnancy.

In addition, the gastroshisis is a direct medical indication for termination of pregnancy. But each such case is considered individually, and requires the risk of possible complications with prematureism.

Treatment of gastrochisis: clinical recommendations when an operation is performed?

The main method of treating gastrochisis is understandable not only to a specialist, but also by a simple person - gutted organs need to be returned inside the abdominal cavity and remove the defect in the front wall of the peritoneum. Optimally, the operation should be carried out immediately after birth, which, unfortunately, is not always possible. Here are clinical recommendations:

If the intestines have inflammatory infiltrates or seriously damaged, multi -stage treatment may be required.
The protruding organs are covered with special coatings of artificial materials, which provide adequate isolation and good conditions for healing of tissues.
Regardless of the presence or absence of surgical treatment, the consequences of the presence of holes on the surface of the natural cover of the body should always take into account. Such a defect is a place of intensive evaporation of water from tissues, so the child needs to introduce an adequate volume of fluid intravenously.
The absence of the skin also violates the correct thermoregulation, so it is necessary to protect a small patient from colds.

Do not forget about the risk of developing infectious complications - microbes can freely penetrate through the hole into the body. For this reason, gastroshisis is usually associated with the need for preventive antibacterial therapy. Another important point - if the insufficiency of the intestinal function prevents the oral intake of food, periodic parenteral nutrition is administered.

Complications in the diagnosis of "gastrochisis"

Complications in the diagnosis "Gastrochizis" are early, that is, arising immediately after birth and are a direct consequence of the defect, and late, developing after the completion of surgical treatment and often chronic in nature. Read more:

Early complications:

This type of complications includes the aforementioned conditions (inflammation, necrosis, etc.) associated with the effects of amniotic fluid on the intestines and impaired blood supply. Thus, the early complications of the gastrochisis include:

Inflammation of the intestinal wall
Intestinal ischemia, followed by necrosis and perforation
Inversion inversion, leading to intestinal obstruction and pathological stretching
Violations of the embryonic development of the intestine can lead to their atresia
The absence of an abdominal wall can be a gate for infections, which leads to complications

Newborns with congenital gastrochisis often have low body weight at birth. There is also an increased risk of developing necrotic enterocolitis (NEC) in prematurely newborn.

Late complications:

Despite the successful surgical treatment and intestines in the abdominal cavity, with a gastrochizis, the intestines are exposed to damaging factors very early.
Later, because of this, the work of this body may be violated.
One of the most common complications is malabsorption and its consequences (poor weight gain, nutrient deficiency).
Among patients with congenital gastroshisis, more often there are disturbances in the gastrointestinal tract and gastroesophageal reflux disease.

What are the forecasts for the baby with this pathology? Read further.

Forecast for a gastroshizis

The forecast in each case of the gastrochisis is individual and depends on the degree of intestinal damage and the presence of complications. The survival of newborns with congenital gastroshisis has improved significantly over the years and now more than 90%.

The correct early (prenatal) diagnosis of the defect and subsequent control of it play a very important role.
Patients with a diagnosis of congenital gastroshisis are currently sent to specialized centers with experience in the treatment of this type of defect.
After successful surgical treatment, they remain under constant medical control for the occurrence of digestive disorders and food absorption.

The congenital gastroshisis was described above, which is the result of an abnormal embryonic development of the abdominal wall. However, it is worth noting that there is also the acquired gastroshizis, that is, the movement of the abdominal organs outside the abdominal cavity, most often as a result of mechanical trauma. Such a acquired pathology may also be a consequence of the discrepancy between postoperative sutures after surgery. Treatment of the acquired form of gastrochisis does not differ from the congenital - requires surgical intervention, which involves the investment of protruding organs in the abdominal cavity and the correct closure of the skin.

Gastrochizis: Parents' reviews after surgery

Gastroshisis is a terrible diagnosis for many future parents. But now medicine does not stand still, and almost all pathologies of fruits and babies are perfectly treated. Read the reviews of other parents after the operation of their kids. You will understand that you are not alone with your problems, and maybe it will inspire you.

Tatyana, 29 years old

When I became pregnant, there was no bounds of joy. But everything did not last long. At 17 weeks, on an ultrasound scan, they diagnosed Gastrochizis. There were so many experiences, re -read a lot of medical and scientific literature. But I realized one thing that I would give birth, despite the fact that everywhere in the recommendations is a termination of pregnancy. The only thing is that the doctors said they would do a cesarean during childbirth so as not to harm the intestines that are already on the outside. The operation was carried out 10 days after birth. Now my daughter is already 5 years old. It develops with its peers, but there are violations in the work of the intestines-there are constipation, then a chair 6-8 times a day. In the kindergarten, educators always notice this and tell me. Otherwise, she is the same as all other children.

Angela, 40 years old

My daughter also had a gastrochisis, it was very difficult to survive. Now everything is fine, she is already 18 years old, she graduates from grade 11. At that time she was very worried. For ultrasound at 20 weeks, it lagged a little in weight from other children, but by the time of birth it was already 3 kg. Therefore, only surgery and rehabilitation remained to survive. No trifles compared to joy when your baby goes to kindergarten or first grade. Now, after a passing of time, I can say for sure that you need to give birth and survive this moment. Everything will be fine!

Elena, 25 years old

The diagnosis of "gastrochisis" was made at 25 weeks. Doctors said that it is desirable to terminate the pregnancy. But I had no doubt that I would give birth no matter what. After childbirth, the child was immediately placed in intensive care. Two weeks were observation, then the operation. Everything went successfully. First, the water was introduced a little, then they began to feed, starting with 2 ml. Such a vice can be experienced, you need to gain only patience. Be sure to make a disability to the baby. It takes a lot of funds for its rehabilitation.