OBGY Radiology


Case 13
Antenatal scan of 17 weeks. Diagnosis please!
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Diagnosis :
Gastroschisis

Discussion
Gastroschisis is a paraumbilical defect involving all the layers of the abdominal wall, with evisceration of abdominal organs, usually the small bowel, on occasion large bowel and stomach. The leading theory in the pathogenesis of gastroschisis is that the defect results from an abnormal involution (persistance) or premature atrophy of the right umbilical vein. Sonographic findings include a small abdominal wall defect, paraumbilical, usually right-sided although there are reports of left-sided gastroshisis in association with persistent right umbilical vein or with situs inversus. Gastroschisis is found either during routine second trimester screening or because of elevated maternal serum a-fetoprotein.

7%4 -30% of fetuses with gastroschisis can have an associated malformation. Associated anomalies related to the bowel herniation are motility dysfunction, intestinal atresia, and volvulus.

Karyotyping is usually not suggested because the incidence of chromosomal abnormalities is not greater than in the general population. Serial sonograms can be performed to screen for intra-uterine growth restriction, signs of bowel involvement and the involvement of other structures that might influence management and prognosis.

Although it appears rational to deliver those fetuses by cesarean section to prevent bowel injury, trauma to the exteriorized bowel can also occur during cesarean section. Recently several reports demonstrated that there was not any difference in outcome between vaginal delivery and elective caesarean section. As such cesarean section should be performed for obstetrical reasons only.



References

http://www.thefetus.net/sections/articles/Gastrointestinal_splenic_and_abdominal_wall/Gastroshisis_elke.html

http://www.wcox.com.au/gastrosc.htm



Dr. Sanjeev Mani, Bandra Holy Family Hospital, Mumbai