Gastroschisis

Etiology: Anterior abdominal wall defect where defect is lateral to umbilicus
Imaging AXR: Multiple loops of bowel outside of abdominal cavity without an encasing sac
DDX:
Complications: Often have gastrointestinal dysmotility for the first year of life
Treatment: Reduced via silo
Clinical: Almost no associated congenital anomalies

Radiology Cases of Gastroschisis

CXR of gastroschisis — CXR shows multiple loops of bowel without an encasing sac wrapped in gauze outside of the abdomen to the right side of the patient. The abdominal cavity is small.

AXR of gastroschisis — Preop AXR (left) shows no bowel gas within the abdomen and multiple bowel loops outside of and to the right of the abdomen without an encasing sac. Postop AXR AP (above right) and lateral (below right) show the bowel loops still outside the scaphoid abdomen but now encased within a silo.

AXR of peripherally inserted central catheter / PICC in the spinal canal — AXR AP shows a left lower extremity PICC that does not follow the course of the iliac vein and whose tip projects at the level of L3 and that projects within the spinal canal on the lateral radiograph. The only gas within the abdomen is in the stomach while all of the small bowel is in a silo outside the abdomen.

AXR of gastroschisis — AXR AP shows multiple loops of bowel in the midline outside of the abdomen that were not encased by a sac and thus were wrapped in a temporary gauze dressing.

Clinical Cases of Gastroschisis

Surgical image of gastroschisis — Surgical image shows the abdominal wall defect with stomach and small bowel protruding out of the abdomen, with no surrounding membranous sac.

Surgical image of gastroschisis — Surgical image shows an anterior abdominal wall defect with the small bowel protruding out of the abdomen, with no surrounding membranous sac. The small bowel loops are dilated. There was an atresia just distal to the cecum and the distal colon was small in caliber. A silo for the abdominal contents was constructed. A gastrostomy and cecostomy were also placed.

Clinical image of gastroschisis — Clinical image shows an anterior abdominal wall defect with stomach and small bowel exposed through an opening on the right side of the umbilicus. Note the absence of a peritoneal sac enclosing the abdominal contents.

Clinical image of gastroschisis — Clinical image shows a dilated stomach (above center) and small bowel (below center) which are not enclosed by a sac.

Surgery Cases of Gastroschisis

Surgical image of gastroschisis — Surgical image shows a silo over loops of bowel not encased by a membranous sac that is being sequentially reduced several days after the initial operation. The small intestine has been almost completely reduced into the abdomen.

Surgical image of gastroschisis — Surgical image shows a prosthetic silo over loops of bowel not encased by a membranous sac that was created by sewing the silo to the fascia on either side of the incision. The silo was then wrapped in cotton gauze and sterile drapes. The patient underwent serial mesh tightening and on day of life eight underwent removal of the silo and final closure of the gastroschisis.