Complications
As treatment of gastroschisis and omphalocele often involves staged or repeated surgical procedures with manipulation of incisions at the umbilicus or surrounding skin, localized infection or necrosis of the skin edge may occur.
These complications respond quickly to routine wound care, usually healing completely within weeks or even days.
The exposure of the extruded gut to amniotic fluid in gastroschisis causes inflammation that often produces a persistent dysmotility. In the vast majority of cases this temporary phenomenon resolves over time.
Approximately 15% of infants with gastroschisis will develop signs of bowel obstruction at some point later in life, especially in the first year after treatment, partly due to the very common occurrence of intestinal malrotation associated with abdominal wall defects.[40][41]
Initial management should involve simple nasogastric decompression; however, occasionally surgical re-exploration is required.
Infants with gastroschisis may have impaired intestinal perfusion and, as such, may be at risk of gut ischemia that can progress to neonatal necrotizing enterocolitis. This occurs in 2% to 18% of infants and is often associated with other risk factors such as very low birth weight, pulmonary insufficiency, and hypotension.[42]
While the gut recovers, the infant requires intravenous alimentation, which is delivered via a peripherally inserted central catheter or central venous catheter. Both of these routes of administration are at risk of becoming infected if not handled with careful and strict sterile technique.
If intestinal function is slow to recover and the infant is dependent on intravenous alimentation, hepatitis, and liver failure may develop as a result of prolonged TPN dependence. Infants who are TPN dependent may have short gut syndrome.
In gastroschisis, as the dyskinetic gut requires parenteral alimentation, the possibility of cholestatic jaundice persists.
In gastroschisis, if the acute injury is associated with ischemic damage that destroys enough of the extruded gut, short bowel syndrome (also known as short gut syndrome) may develop. Infants who are TPN dependent may have short bowel syndrome.
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