The Two Abdominal-Wall Defects
Gastroschisis
- No covering sac — bowel is exposed to the environment
- Defect para-umbilical (usually right of the cord)
- Bowel often thickened, matted, inflamed (exposure to amniotic fluid)
- Fewer associated anomalies, but more bowel-related problems (atresia, ischaemia)
- Associated with prematurity & SGA
Omphalocele (exomphalos)
- Covered by a sac (peritoneum + amnion) — through the umbilicus
- Herniation into the cord; may contain liver
- High rate of associated anomalies — cardiac, chromosomal (trisomies), Beckwith–Wiedemann, Pentalogy of Cantrell
- The sac gives some protection — often less immediately urgent unless ruptured
Gastroschisis — a Neonatal Emergency
Consequences of exposed, uncovered bowel
Open loops of bowel exposed to the environment
Heat lossLarge evaporative/radiant surface → hypothermia
Fluid & protein lossMassive third-space loss → dehydration, hypovolaemia, haemoconcentration, acidosis
Bowel injuryIschaemia, kinking, infection/sepsis, necrotising enterocolitis
Because the bowel is unprotected, gastroschisis requires urgent surgery (and staged closure is often needed). The anaesthetic concerns that follow — protection of the herniated viscera, prevention of heat loss, treatment of dehydration & hypothermia, sepsis risk, prematurity/SGA physiology, screening for associated (esp. cardiac) anomalies, and large-volume fluid resuscitation — flow directly from this picture.