Photo credit to Dr Ajoy
Both Omphalocele and Gastroschisis are congenital abdominal wall defects. Omphalocele is a central wall defect where there is herniation of intestines, liver, etc. into the umbilical cord. It is usually covered by a membrane. Gastroschisis is a Paraumbilical herniation of intestinal content and it is not covered by the sac.
During the development stage inside the womb up to 11 weeks, abdominal contents stay outside the abdominal wall but after that, it returns to normal position. Failure to do so results in omphalocele or Gastroschisis. Omphalocele is usually associated with other congenital anomalies like Trisomy 21, Trisomy 18, etc. BUT Gastroschisis doesn’t. The incidence of Omphalocele is 1 in 5386 births and Gastroschisis is 1 in 2229 births. Gastroschisis is more commonly seen in younger mothers.
How to diagnose Omphalocele and Gastroschisis
Both the conditions can be diagnosed by foetal ultrasound during the 2nd or 3rd trimester of pregnancy.
Foetal echocardiography can be done to diagnose any cardiac abnormality of the foetus.
After birth both the conditions can be diagnosed by physical examination.
An X-ray can be done to know any other bony abnormality.
Risk factors
1. Genetic predisposition is seen in the majority of cases.
2. Smoking mothers
3. Drugs like SSRI
Signs and symptoms
Abdominal contents are seen protruding outside. The infants’ abdomen is too small as the contents are not there, causing difficulty in taking respiration. Features of other congenital anomalies are seen if associated with it as earlier mentioned it is more common in omphalocele
Treatment of omphalocele and gastroschisis
Treatment is surgical. Success depends on various factors like gestational age, size of the omphalocele or gastroschisis, associated chromosomal anomalies etc.
small size omphalocele is treated with a single surgery. The sac is repositioned inside the abdominal cavity.
Large size omphalocele needs multiple stages of surgical approach.
Survival rate
Gastroschisis has an excellent survival rate after surgery. it is about 95 per cent.
But unfortunately in omphalocele, the survival rate is 75 per cent as it is associated with many other chromosomal as well as cardiac anomalies.