A 36-week female infant with gastroschisis has just arrived in the neonatal intensive care unit. The appearance is shown below.

[center][/center]

 

 

[size=20px]The most appropriate operative management of this infant is which of the following?

 

A Ostomy creation

 

B Enlargement of the defect

 

C Sutureless closure

 

D Excision with primary anastomosis

 

E Placement of the bowel in a silo​[/size]

If bowel unviable - D

If bowel viable - C

Edited November 6, 20224 yr by Gunduz Aghayev

D

D

D

correct answer

B Enlargement of the defect

​

Closed (aka vanishing or closing) gastroschisis is a rare clinical entity that results from closing of the umbilical ring around herniated bowel contents. This clinical entity has been historically described as having a high morbidity and mortality in this infant population. New studies have shown that there has been improved long-term survival. There is a recognition that this is a spectrum of disease with different severity based on the condition of the external bowel. The majority of the morbidity from closed gastroschisis is secondary to subsequent short gut syndrome and need for long term parenteral nutrition. The key to the operative management of these infants is to preserve as much intestinal length as possible after accounting for any frankly necrotic bowel that needs to be excised. After enlargement of the fascial ring the external bowel should be reduced with a plan for return exploration in 6-8 weeks. Often external tissue that is fused without distinctly identifiable bowel loops can lead to subsequent viable bowel.