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Fetal Gastroschisis
Sami Backley1, Allison Speer, Anthony Johnson
1Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, and the Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas.
Insights
Gastroschisis is a congenital abdominal wall defect involving visceral herniation. Current evidence suggests a model involving embryonic disruption, vascular issues, and environmental factors leading to this condition.
Area of Science:
- Developmental Biology
- Pediatric Surgery
- Medical Genetics
Background:
- Gastroschisis is a common congenital abdominal wall defect.
- It involves herniation of abdominal viscera through a paraumbilical defect.
- The exact cause involves a complex interplay of factors.
Purpose of the Study:
- To provide an overview of gastroschisis.
- To cover embryology, pathophysiology, and diagnosis.
- To discuss management and potential fetal interventions.
Main Methods:
- Review of current evidence and established models.
- Synthesis of information on embryogenesis and pathology.
- Compilation of clinical management strategies.
Main Results:
- Gastroschisis results from early embryonic morphogenetic disruption.
- Vascular compromise and environmental influences exacerbate the defect.
- A model involving defective body wall formation and vascular factors is supported.
Conclusions:
- Gastroschisis pathogenesis is multifactorial.
- Understanding embryology and pathophysiology is key to management.
- This series offers a comprehensive guide to gastroschisis care.
Abstract:
Gastroschisis, a common congenital defect of the abdominal wall, is characterized by varying degrees of visceral herniation of the bowel and may include the stomach, liver, or bladder through a paraumbilical defect. Gastroschisis arises from a complex interplay of early embryonic morphogenetic disruption, vascular compromise, and environmental influences. Though the exact initiating events have yet to be determined, the weight of current evidence supports a model in which defective right-sided body wall formation is compounded by vascular and environmental factors that lead to a paraumbilical full-thickness defect with extruded, uncovered viscera. This Clinical Expert Series provides an overview of embryology, pathophysiology, categorization of complexity, prenatal diagnosis, antenatal monitoring, postnatal surgery, and potential options for fetal intervention for gastroschisis.
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