Gastroschisis

Overview

What is gastroschisis?

Gastroschisis is a birth defect where your baby’s intestines (stomach, large or small intestines) exit their body from a 2 to 5-centimeter hole beside their belly button during fetal development. This condition happens early during pregnancy when your baby’s abdominal wall doesn’t form correctly, leaving an opening for their organs to escape. Your baby’s organs float in amniotic fluid inside of your uterus, which causes irritation and swelling. Surgery is necessary to replace your baby’s organs inside their body.

What is the difference between gastroschisis and omphalocele?

Both gastroschisis and omphalocele are birth defects where your baby is born with their abdominal organs outside of their body. The difference is that a membrane covers your baby’s organs with an omphalocele diagnosis, and no membrane covers your baby’s organs during gastroschisis. This difference can usually be seen on ultrasound before your baby is born.

Who does gastroschisis affect?

The cause of gastroschisis is unknown, so there is a risk that it could happen to anyone during pregnancy. Studies by the Centers for Disease Control and Prevention note that gastroschisis might be more common in younger people who become pregnant and those who use tobacco, alcohol or other drugs during pregnancy.

How common is gastroschisis?

Gastroschisis is rare and affects around one in 2,000 babies annually in the U.S.

Symptoms and Causes

What are the symptoms of gastroschisis?

During pregnancy, you will not feel any symptoms of your baby’s gastroschisis. Some findings for the baby on ultrasound may include:

  • Stomach, large or small intestines located outside of your baby’s body.
  • Swollen intestines.
  • Twisted intestines.
  • Low body temperature (hypothermia).

What causes gastroschisis?

Gastroschisis is the result of your baby’s abdominal wall not forming completely during fetal development in the womb. The direct cause of gastroschisis is unknown. If you are planning to become pregnant, talk with your healthcare provider to discuss ways to prevent birth defects.

Diagnosis and Tests

How is gastroschisis diagnosed?

A gastroschisis diagnosis occurs either during pregnancy or once your baby is born. Diagnosis usually occurs between 18 and 20 weeks of pregnancy with routine prenatal tests that check for birth defects in your baby. These tests include:

  • Ultrasound: An imaging test using sound waves to see details of soft tissues inside your body.
  • Blood screening: A blood test that measures substances in your blood, including alpha-fetoprotein, which, if tested at higher than normal levels between 18 and 22 weeks, could be a sign of gastroschisis.
  • Magnetic resonance imaging (MRI): An imaging test to take a detailed picture of the inside of your body and the baby.

Management and Treatment

How is gastroschisis treated?

Although a gastroschisis diagnosis can happen during pregnancy, treatment can’t start until after your baby is born.

Surgery is necessary to place your baby’s organs back inside their body. Surgery also repairs the hole near their belly button to prevent their organs from returning back outside of their body.

Depending on the severity of the condition and how many organs are outside of your baby’s body, there are two types of surgery to relocate your baby’s organs and repair their abdominal wall:

  • Primary repair: If possible, your baby will receive surgery immediately after they are born to move the organs back into their body and repair the hole in their abdomen.
  • Staged repair: If the gastroschisis is more complicated, your baby’s surgeon will perform surgery slowly in stages. A staged repair could be most effective if your baby isn’t healthy enough for surgery, or if their abdomen isn’t big enough to hold all of their organs.

From the time your baby is born to the time of their surgery to repair gastroschisis, your baby’s surgeon will place their exposed organs in a plastic pouch called a silo to prevent infection, dehydration and damage.

After the initial surgery to replace your baby’s organs, additional surgery to repair your baby’s abdomen muscles or intestines may be necessary.

Are there any complications of gastroschisis surgery?

There is a chance that complications could occur after gastroschisis surgery. Post-surgery complications could include:

  • Infection at the surgical site.
  • Difficulty eating.

An intravenous (IV) line in their vein or a nasogastric tube that goes through your baby’s nose, esophagus and into their stomach may be necessary until your baby can eat again.

Are there any bowel complications after gastroschisis treatment?

Up to 25% of babies born with gastroschisis have developmental problems with parts of their intestines. Additional surgery is necessary to address these conditions including:

  • Bowel resection: Surgery to remove segments of damaged intestines.
  • Ileostomy or c**olostomy**: Surgery to bring one end of the intestine through an opening in the abdominal wall where stool will drain into a bag, attached to your baby’s belly.

What are the side effects of gastroschisis?

Babies born with gastroschisis may face some health issues in their lifetime including:

  • Premature birth: Babies with gastroschisis can be born prematurely.
  • Intestinal blockage: After surgery, your baby may have narrowing of the intestines that could prevent food and stool from moving through their intestines.
  • Short bowel syndrome: In rare cases, some babies are missing parts of their intestines, which may prevent your baby from absorbing nutrients from food.

When can I bring my baby home from the hospital after gastroschisis surgery?

Depending on the severity of your baby’s condition, they will stay in your hospital’s neonatal intensive care unit (NICU) from two weeks to several months. The duration of their hospital stay is dependent on close monitoring of their treatment to make sure that they are healing properly and can eat and pass food through their digestive system. Additional surgery may be necessary to combat any complications from the condition, which could prolong their stay.

Prevention

How can I reduce my risk of having a baby with gastroschisis?

You can reduce your risk of having a baby with gastroschisis by:

  • Not smoking or using tobacco products.
  • Don't drink alcohol during pregnancy.
  • Don't take opioids (prescription painkillers) during pregnancy.
  • Eating a nutritional, well-balanced diet.

Outlook / Prognosis

What can I expect if my baby has gastroschisis?

Once your baby is born, they will need surgery to return the organs inside the body and close the abdomen. If the opening in your baby’s abdomen is large, your healthcare provider will slowly return your baby’s organs over a few days or weeks after birth.

Your baby will be on IVs while they recover from surgery in the hospital to give them nutrients and antibiotics to prevent infection. Your baby will not be able to drink breastmilk or formula immediately after birth and surgery. Your healthcare provider will advise on when it is safe to begin feeding your baby breastmilk or formula.

If gastroschisis is the only health condition affecting your baby, they will likely make a full recovery and grow and develop normally. There is a risk that digestive and gastrointestinal complications could arise later in your baby’s life, but your baby’s healthcare provider will discuss the prognosis with you.

Living With

How do I deliver my baby with gastroschisis?

It's best to deliver your baby in a hospital with specialists who are able to care for your baby’s condition in a neonatal intensive care unit (NICU). Babies with gastroschisis may be safely born vaginally or by cesarean section (c-section). Your obstetrician will help you to determine the delivery method best for your baby.

When should I see my baby’s healthcare provider?

After surgery, you should visit your baby’s healthcare provider if your baby experiences:

  • Swelling or redness near the surgical site.
  • Fluid leaking from the surgical site.
  • Vomiting or not being able to pass stool.

What questions should I ask my doctor?

  • What are the long-term complications of gastroschisis?
  • How long will my baby be in the hospital after surgery?
  • When can I start feeding my baby breastmilk or formula?

A note from Cleveland Clinic

While it may be scary for you to see your baby born with their organs outside of their body, the prognosis after surgery to replace their organs into their body is very positive. Your healthcare provider will be available to answer any questions that you might have about your baby’s condition and guide you through their surgery and recovery process in the hospital.

Last reviewed by a Cleveland Clinic medical professional on 01/19/2022.

References

  • Centers for Disease Control and Prevention. Gastroschisis. (https://www.cdc.gov/ncbddd/birthdefects/gastroschisis.html) Accessed 1/20/2022.
  • March of Dimes. Gastroschisis. (https://www.marchofdimes.org/complications/gastroschisis.aspx) Accessed 1/20/2022.
  • Merck Manual. Abdominal Wall Defects (Omphalocele and Gastroschisis). (https://www.msdmanuals.com/home/children-s-health-issues/birth-defects-of-the-digestive-tract/abdominal-wall-defects-omphalocele-and-gastroschisis) Accessed 1/20/2022.
  • National Organization for Rare Disorders. Gastroschisis. (https://rarediseases.org/rare-diseases/gastroschisis/) Accessed 1/20/2022.
  • Gastroschisis. (https://www.statpearls.com/ArticleLibrary/viewarticle/22117) Accessed 1/20/2022.

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