Which of the following statements regarding the abdominal wall defect shown in the folllowing photograph is true?

 

 

 

 

[size=20px]a this can reliably be predicted on prenatal ultrasound

 

b tolerance of full enteral feeds is expected in the neonatal period

 

c the exposed tissue may represent a significant length of intestine

 

d prenatal bowel dilation is an indication for early delivery

 

e delivery at lung maturity can prevent this outcome[/size]

C

C

C

C

C

C

C

A

C

Correct answer

C the exposed tissue may represent a significant length of intestine

 

The photograph depicts a closed gastroschisis with trapped remnant bowel. The trapped, atretic bowel typically represents most of the midgut from the proximal jejunum to the transverse colon. In cases where gastroschisis is detected prenatally, the development of intra-abdominal bowel dilation may be indicative of bowel atresia. Closed gastroschisis may additionally manifest by a disappearance of extra-abdominal bowel or a stable appearance of a hyperechoic cluster of extra-abdominal bowel that remains unchanged in the face of increasing intra-abdominal bowel caliber. Prenatal ultrasound may not always diagnose this condition.

 

Babies that have been delivered as early as 30 to 32 weeks with findings of intra-abdominal bowel dilation usually have the atresia already defined. Therefore, there is no benefit in early delivery for the finding of bowel dilation alone in the presence of gastroschisis. The amount of bowel lost with closed gastroschisis is often substantial leading to severe short gut syndrome with significant morbidity and mortality. However, enteral feeds have been successful in some babies with lesser amounts of bowel loss or those who have undergone bowel lengthening procedures such as the Bianchi or serial transverse enteroplasty (STEP) procedure.