Interesting Clinical Cases - A Rare Case of Gastroschisis by Subrata Bhattacharya

Dr. Subrata Bhattacharya,
Silchar Medical College & Hospital,
Silchar, Assam


 “ Listen to me little fetus, precious homo incompletus.

 As you dream your dreams placental, don”t grow nothing accidental. ”

                                                                                             --- Jerry Adler

Gastroschisis, one of the major congenital anterior abdominal wall defects, is a paraumbilical herniation (mostly right-sided) of gastrointestinal structures (usually excluding liver) into the amniotic cavity. A unique case of Gastroschisis encountered in the Dept. Of Obs. & Gynae., SMCH is presented here which revealed many variations both epidemiological & pathological.


Mrs. SS, 30 yrs Hindu, booked case; married since 9 months, hailing from a village of District Cachar was admitted in the Department of Obs. & Gyne., SMCH on 7th March, 2007 with the diagnosis of Primigravida at 20 weeks pregnancy with fetal anomaly (Anterior wall defect - possibly Gastroschisis). There is no H/O addiction in any form. Her physical examination was within normal limits (except mild pallor).Routine antenatal Investigation reports were normal (except Hb 10.2).  Her Anomaly scan revealed Anterior abdominal wall defect with abdominal contents (liver, stomach, bowel loops) protruding outside the abdominal cavity. The liquor volume was less & EGA was 19 weeks 3 days +/- 1 week. A second anomaly scan by a separate observer was similar to the previous findings.

The couple decided to get the pregnancy terminated after being informed of the consequences. A informed consent was taken for termination of her pregnancy with Misoprostol. She had spontaneous expulsion of the foetus (with a rare variant of Gastroschisis) following Misoprostol induction. She was discharged on the next day following check D & E. The foetus was not allowed to undergo autopsy by the patient party due to religious/social reasons.


The etio-pathogenesis of Gastroschisis (also known as Laparoschisis, Abdominoschisis) is not known for certain. Most cases are sporadic with Familial cases reported (3.5 % risk in siblings). However, unlike Omphalocoele, there is usually no chromosomal associations with Gastroschisis. Few proposed embryological associations include (1) Abnormal involution of right umbilical vein, which occurs normally at 6th -7th week (2) Vascular accident involving Omphalomesenteric artery (less likely). Substance abuse (esp. vasoactive substances like Cocaine, Nicotine, Decongestants, Aspirin) by mothers is also implicated. Incidence of Gastroschisis ranges from 1:10,000 to 1:15,000 live-births with 6 - 10 times higher incidence in teenage mothers (than in mothers > 25 years). The D/D includes Omphalocoele, Body stalk anomaly (LBW complex), Physiologic gut herniation, Cloacal / Bladder exstrophy, Umbilical hernia, Amniotic band syndrome, Pentalogy of Cantrell, etc. Detection of Gastroschisis is usually done with USG, elevated MS-AFP & excess amniotic fluid. Management of a case of Gastroschisis following delivery includes surgical repair, Antibiotics & Temperature regulation. Prognosis: IUGR is seen in upto 50% cases. Premature delivery is common (90% survival with deaths mainly resulting from prematurity, sepsis or bowel complications). 10-15% cases have persistent disability (Motility disorders, Short bowel syndrome). Oligohydramnios suggests fetal distress while Polyhydramnios suggests Bowel obstruction or Atresia. It is very important to plan for delivery at a tertiary care center with good neonatology and pediatric surgery for proper management and repair after birth. Our case was unique for various epidemiological & pathological reasons:- Age of mother > 30 years; No H/O addiction in any form by the mother; very short duration of gap between marriage and the conception; decreased liquor volume in utero and the presence of liver in the protruded abdominal contents.



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