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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 17  |  Issue : 2  |  Page : 115-116

Prenatal diagnosis of gastroschisis on ultrasonography


Department of Radiology, St. John's Hospital, Kattappana, Kerala, India

Date of Submission10-Feb-2020
Date of Acceptance25-Apr-2020
Date of Web Publication18-Jun-2020

Correspondence Address:
Reddy Ravikanth
Department of Radiology, St. John's Hospital, Kattappana - 685 515, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_9_20

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  Abstract 


Gastroschisis is an abdominal wall defect resulting from ischemia to blood vessels that supply the abdominal wall during the first trimester of pregnancy. The injury results in an opening in the abdominal wall that allows the abdominal contents, most often intestines and stomach, to develop outside the abdominal cavity. Early antenatal diagnosis of gastroschisis allows parental counseling regarding prognosis and optimizes management through a multidisciplinary approach.

Keywords: Gastroschisis, parental counseling, polyhydramnios, ultrasonography


How to cite this article:
Ravikanth R, Khanapure VP. Prenatal diagnosis of gastroschisis on ultrasonography. Apollo Med 2020;17:115-6

How to cite this URL:
Ravikanth R, Khanapure VP. Prenatal diagnosis of gastroschisis on ultrasonography. Apollo Med [serial online] 2020 [cited 2020 Jul 11];17:115-6. Available from: http://www.apollomedicine.org/text.asp?2020/17/2/115/287094




  Introduction Top


Gastroschisis is a small abdominal fissure lateral to an intact umbilical cord, generally to the right. The bowel herniates throughout the fissure and is not covered by a membrane. Unlike most other birth defects, the reported rates of gastroschisis have increased over the past 25 years from 0.1–1.0/10,000 births to 3.0–5.0/10,000 births in many developed and developing countries.[1]


  Case Report Top


A 28-year-old primigravida presented to the hospital at 20 weeks of gestation for anomaly scan. Ultrasonography revealed fetal movements and fetal heart sounds and reduced abdominal circumference for the gestational age with free-floating intestines and liver [Figure 1]a. The herniation of bowel loops and viscera occurred through an anterior abdominal wall defect in the right parasagittal location. Femoral length, biparietal diameter, and head circumference were corresponding to the gestational age [Figure 1]b. The amniotic fluid index was within normal limits. A sonological diagnosis of gastroschisis was made, and the parents were offered counseling regarding the same. Alfa-fetoprotein was markedly elevated.
Figure 1: (a) Antenatal longitudinal ultrasonography image of the fetus at 20-week gestational age demonstrating herniation of the bowel loops and abdominal viscera through a defect in the anterior abdominal wall. (b) Antenatal axial ultrasonography image demonstrating herniated liver through a right paramedian defect in the anterior abdominal wall

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  Discussion Top


Gastroschisis is a sporadic condition with incidence of 1 in 10,000 live births.[2] However, the association of gastroschisis with other anomalies is rare as compared to omphalocele.[3] Gastroschisis is a congenital anterior abdominal defect leading to herniation of the intestines and solid viscera. The defect is a result of omphalomesenteric vessel obstruction during embryonic development. During the 4th week of development, the lateral body folds move ventrally to fuse in the midline, forming the anterior abdominal wall. Incomplete fusion of the lateral body folds results in herniation of the solid viscera and bowel loops through the rectus muscles lying to the right of the umbilicus. Various theories proposed regarding the abdominal wall defect in gastroschisis are rupture of the amnion surrounding the umbilicus leading to herniation, disruption of right vitelline artery causing weakening of the anterior abdominal wall leading to herniation, embryological failure of the mesoderm to form the anterior abdominal wall, abnormal folding of the abdominal wall leading to a ventral defect causing herniation, and right umbilical vein involution leading to weakening of the anterior abdominal wall and subsequent herniation of the viscera.[4] Antenatal ultrasonography features of gastroschisis include stomach dilatation, bowel dilatation, abnormal umbilical artery Doppler findings, intrauterine growth restriction, and polyhydramnios. Unlike omphalocele, herniation occurs within the amnion without any covering membrane. The hallmark in the diagnosis of gastroschisis is the normal insertion of umbilical vessels. Although the incidence of chromosomal anomalies in gastroschisis is rare, the condition is frequently associated with intestinal complications such as intestinal malrotation/nonrotation, intestinal atresia, intestinal stenosis, intestinal ischemia, necrotizing enterocolitis, bowel matting malabsorption, and jejunoileal disruption.[5] Exposure of fetal intestines to amniotic fluid can lead to inflammation and subsequent complications.[6]


  Conclusion Top


Early antenatal diagnosis of gastroschisis allows parental counseling regarding prognosis and optimizes management through a multidisciplinary approach.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mastroiacovo P. Risk factors for gastroschisis. BMJ 2008;336:1386-7.  Back to cited text no. 1
    
2.
Rumack CM, Wilson SR, Charboneau JW, editors. Diagnostic Ultrasound. 2nd ed., Vol. II. Philadelphia: Elsevier Mosby: 1998. p. 1162-6, 1193, 1224-5.  Back to cited text no. 2
    
3.
Agarwal R. Prenatal diagnosis of anterior abdominal wall defects: Pictorial essay. Indian J Radiol Imaging 2005;15:361-72.  Back to cited text no. 3
  [Full text]  
4.
Alam A, Sahu S, Indrajit IK, Sahani H, Bhatia M, Kumar R. Gastroschisis-antenatal diagnosis. Med J Armed Forces India 2011;67:169-70.  Back to cited text no. 4
    
5.
Ravi PR, Gupta A. Management of gastroschisis in a remote hospital. Med J Armed Forces India 2008;64:175-6.  Back to cited text no. 5
    
6.
Goyal R, Kumar G, Dubey R, Malakar PK. Management of gastroschisis in a peripheral hospital. MJAFI 2007;63:392-3.  Back to cited text no. 6
    


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