Drs Challis, Ffarine, Morrow, Ritchie, Ryan 01 January 2001
The cause of gastroschisis remains unknown but may be due to an embryological aberration of the vitelline vessels resulting in a paramedian defect distinct from the umbilical stalk, usually on the right. The herniated gut is commonly short and malrotated, indicating a more complex aetiology than merely an abdominal defect. The incidence of the condition appears to be increasing and it is more common among younger gravidas. Smoking and drug abuse are other possible factors. If the anterior abdominal wall is carefully scrutinized, gastroschisis is not usually missed. Bowel herniates through a paramedian defect distinct from the umbilical vessels. Due to exposure to the amniotic fluid and as a consequence of impaired circulation, the bowel may be tortuous, matted and thickened. The bowel can be some distance from the fetus, often around the feet, so the whole amniotic cavity must be scanned. Gastroschisis is associated with elevated maternal serum alpha-fetoprotein levels. In comparison with omphalocele, associated anomalies are uncommon and may only be found in about 5% of cases. A cardiac examination is usually recommended. Karyotypic abnormalities are rare (< 0.5%).
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