University Hospital Southampton NHS Foundation Trust

Gastroschisis

Gastroschisis is the condition in which a baby has a small hole in the front of the abdomen, just to the side of the umbilical cord, through which some of the bowel (intestine) is protruding. This bowel is easily visible on the ultrasound scan.

This is a rare problem, which occurs in around one in every 3000 births, and there is currently no known cause.

What happens at the delivery?

It may be possible for you to deliver your baby in the normal way unless there are other reasons for requiring Caesarean Section. However, we would recommend, that your baby be delivered at the Princess Anne Hospital and your baby will be transferred to the Neonatal Unit soon after delivery.

Initial Management

Following delivery the bowel will be wrapped in a protective film to reduce heat and fluid loss. A drip will be placed into a small vein so that intravenous fluids can be given, as your baby will not be able to feed in the normal way. A tube will be passed through your baby’s nose into the stomach to drain away the bile (green fluid) that collects here. This lessens the risk of vomiting and reduces discomfort.

Treatment

Shortly after delivery we will start treatment to put the intestine back inside. It is usually possible to slide the intestine into a plastic bag (pre-formed silo) where it will remain for a few days. During this time the intestine will be gently squeezed back inside the baby’s abdomen. Once the intestine is all back in, the bag will be removed and dressings placed over the hole. The hole will then heal up over the next 2 weeks. Using this technique most babies do not need an operation.

If it is not possible to get the intestine into the bag, an operation under anaesthetic may be needed. Usually it is possible to put the intestine inside and stitch the hole closed but this may be quite difficult if there is not enough room in the abdomen. In this case a temporary envelope made of plastic sheeting, called a surgical silo, will be constructed on the outside of the baby’s abdomen to hold the bowel.

The silo would then be made smaller every day or so, so that the intestine is usually back inside the abdomen by 10 -14 days. A second operation is needed to remove the silo and close the muscles and skin.

If the closure is tight the baby may need help with breathing for a few days.

The baby will be given analgesia (painkillers) to help alleviate any pain or distress.Gastroschisis

Is Gastroschisis associated with any other congenital problems?

Gastroschisis is not normally associated with other congenital anomalies. We expect most babies born with this condition to survive normally.

In some babies with Gastroschisis there is a gap in the bowel called an atresia. This may be noticed at the first operation or not be suspected until around four to six weeks of age if the baby is not able to tolerate milk. X-rays are carried out to confirm whether an atresia is present. If an atresia is confirmed, the baby would need a further operation to join the bowel together.

In a small number of babies the Gastroschisis is complicated by further problems with the bowel that are not normally detected before the baby is born. The blood supply to the bowel is sometimes interrupted resulting in parts of the bowel being irreversibly damaged or missing. This is known as short bowel syndrome. It could mean long term hospitalisation and drip feeding. Sadly many of these babies do not survive.

After the operation

Other complications occasionally encountered after the operation are wound infections, inflammation/infection of the bowel and further obstruction of the bowel. We will keep you fully informed of your baby’s condition and discuss developments as they arise.

Can I feed my baby?

Because the bowel has been outside the abdominal cavity and has been subjected to movement and bruising by the baby’s activities, it is often extremely slow to work. Consequently the baby is unable to be fed milk in the usual way for a period of time, usually about 3 – 6 weeks.

During this time your baby will need drip feeds (Parenteral Nutrition) through a long line. This line is usually placed in a small vein in an arm or leg and fed through into a large vein. Sometimes an operation under anaesthetic is necessary to insert the line directly into a large vein.

It should be possible for the baby to grow quite normally on this form of feeding while the bowel is recovering. Milk feeds will be slowly introduced and increased, as the baby is able to tolerate them. Once recovery has occurred the baby should be able to feed normally, either by bottle or breast.

Long-term and Follow-up

Following discharge from the ward, there will be regular check-ups in order to monitor your baby’s progress. Your baby will be seen in the outpatient’s department, it may be possible for this follow up to take place at your local hospital.

Your baby should be able to feed and wean normally. Some babies with Gastroschisis are sometimes slower at establishing weight gain and some may have problems with constipation but these are normally short term problems.

Babies who have had a surgical silo will not have an umbilicus (tummy button) but it is now possible to have surgery later in childhood to create one.

Following an operation there is always a small risk of future obstruction occurring. If your baby has a bilious vomit or a distended abdomen medical advice should be sought.

Parent to parent link

Many parents who have experienced this same condition with their baby have indicated that they would be willing to speak to other expectant parents about this. To find out more about our parent link, please speak to the nursing staff when you visit or contact us.

Disclaimer

University Hospital Southampton NHS Foundation Trust produce guidelines as an aid to good clinical practice. They represent recognised methods and techniques of clinical practice, based on published evidence. The ultimate judgement regarding a particular clinical procedure or treatment must be made by the clinician in the light of the clinical data presented by the patient and the diagnostic or treatment options available. The guidelines issued are not intended to be prescriptive directions defining a single course of management and departure from the local guidelines should be fully documented in the patient's case notes at the time the relevant decision is taken.