Closed gastroschisis: Antenatal and postnatal features

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Fetal Medicine

Background:

• Gastroschisis is a congenital defect where the intestines and other abdominal organs protrude outside the body through an abdominal wall opening.
• The natural history and potential complications of antenatally diagnosed gastroschisis, particularly concerning spontaneous closure of the defect, require further elucidation.

Purpose of the Study:

• To describe cases of antenatally diagnosed gastroschisis with spontaneous closure of the abdominal wall defect around the prolapsed midgut.
• To highlight the spectrum of outcomes, including midgut infarction and short bowel syndrome, associated with this phenomenon.
• To propose the term "closed (or closing) gastroschisis" to describe this specific presentation.

Main Methods:

• Retrospective review of four cases with antenatally diagnosed gastroschisis.
• Detailed analysis of abdominal wall defect closure, midgut viability, and associated intestinal atresia.
• Correlation of antenatal ultrasound findings with postnatal outcomes.

Main Results:

• Two cases experienced near-total midgut infarction and short bowel syndrome due to defect closure.
• One case presented with jejunal and colonic atresia and significant midgut damage, but some bowel viability.
• One case showed complete ring closure without intestinal loss; serial ultrasounds revealed bowel dilatation, prompting preterm delivery.
• Three of the four infants are alive and well.

Conclusions:

• Spontaneous closure of the gastroschisis defect can occur antenatally, leading to a range of severe complications.
• Serial antenatal ultrasound is crucial for monitoring bowel changes and guiding delivery timing.
• The term "closed (or closing) gastroschisis" is proposed to accurately describe this clinical entity.