ABDOMINAL WALL DEFECTS: GASTROSCHISIS, DEFINITION, EPIDEMIOLOGY, PATHOGENESIS, TYPES, DIAGNOSIS AND MANAGEMENT

Abstract

Introduction: Abdominal wall defects are common congenital anomalies, both gastroschisis and omphalocele conform to fetal developmental anomalies that favor multidisciplinary support before and after birth. Outcomes for newborns with gastroschisis usually depend on the distinctive features of the abdominal wall defect and underlying intestinal viability, whereas omphalocele outcomes are determined by the size of the defect and the presence of other related anomalies.

Objective: to detail current information related to the two fetal abdominal wall defects, especially gastroschisis definition, epidemiology, pathogenesis, types, diagnosis and management.

Methodology: a total of 48 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 36 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fetal abdominal wall defects, gastroschisis, prenatal anomalies, surgery and prosthetic silo.

Results: The incidence of gastroschisis ranges from 0.4 to 3 per 10,000 births and shows an upward pattern, the incidence of omphalocele ranges from 1.5 to 3 per 10,000 births. About 10% of infants with gastroschisis have intestinal stenosis or atresia because of vascular insufficiency due to volvulus or compression of the vascular pedicle by a narrowing abdominal ring. Periconceptional genitourinary tract infections were significantly associated with gastroschisis (OR, 1.5; 95 % CI, 1.3 to 1.9). Other significant associations presented in various studies with gastroschisis pregnancies include smoking (odds ratio (OR), 2.86; 95 % CI, 2.22-3.66), history of pregestational or gestational diabetes (OR, 2.81; 95 % CI, 1.42-5.5), and use of antidepressant medications (OR, 4.4; 95 % CI, 1.38-11.8).

Conclusions: Abdominal wall defects are common congenital anomalies, both gastroschisis and omphalocele represent different embryological outcomes, which depend on accurate prenatal diagnosis and referral to a multidisciplinary fetal center. Gastroschisis is a congenital anomaly of the rudimentary umbilical ring, in which there is herniation of a variable portion of viscera through the defect, with no membrane or covering sac, and its prevalence has been steadily increasing. Gastroschisis is classified into simple and complex types. Prenatal ultrasound scans can diagnose gastroschisis as early as 12 weeks of gestation. Routine preterm delivery or elective cesarean section has not been shown to improve outcome. Surgical management after birth is aimed at reduction of the herniated viscera and closure of the abdominal wall. Survival rates are usually high; however, the prognosis depends on the state of the bowel at birth. Those affected with significant intestinal alteration at birth are at higher risk of premature death or later complications. Future fetal surgery could improve the outlook and management of the condition.