Some intrauterine developmental defects lead to serious problems. One of these diseases is gastroschisis. When the disease occurs, the internal organs fall out through a small defect that is located to the right of the umbilical cord.
What is gastroschisis and disease code according to ICD-10
When the disease through the hole in the anterior abdominal wall, the intestinal loops come out. Its size is less than 4 cm, in its area there is no peritoneum completely. The pathology is at the junction of the navel and the normal site.
Code of the disease according to ICD-10: Q79.3.
Released organs have a special form: the stomach and intestine are dilated, the walls with infiltrates. The small and large intestine has a narrow root that corresponds to the diameter of the hole.
Causes of pathology in the fetus
As already noted, the cause of the defect is the violation of embryogenesis in the formation of the peritoneum.
Violation of the umbilical vein blood flow leads to ischemia, meso- and ectodermal defects. Forming the abdominal cavity may not correspond to the parameters of internal organs. This leads to loss.
Factors that adversely affect fetal weight gain significantly increase the probability of pathology development. These include:
- too young mother's age,
- addiction,
- smoking.
The risk of developing pathology in the fetus of a smoking woman is 50% higher than that of a non-smoker. The probability of developing gastroschisis in a child increases to 6-8 times, if the mother at the time of delivery is not 25 years old.
Symptoms of
There is a hole in the front wall of the abdomen, its diameter is 2-4 cm. Through it are visible intestines, welded together.
The intestine itself is filled with meconium, but is swollen and swollen. The navel is usually formed. Parts of the falling internal organs are not covered with a hernial sac. Other organs may fall out, but the liver always remains in its place.
Additionally, there may be other manifestations of the disease. These include a decrease in the length of the intestine by 10-25% compared with the normal development of organs. There is an impassable overgrowing and abnormal attachment of the mesentery.
With a complicated form, the disease is associated with other intrauterine malformations. These include:
- midrange inversion,
- stenosis,
- necrosis or intestinal perforation,
- cryptorchidism.
Complications of
If the form is complicated for a longer time, the child is on parenteral nutrition. There is a high risk of sepsis and death.
The incidence of complications is up to 30% of cases.
The most rare complication is intrauterine death. It occurs in the last trimester of pregnancy. A prerequisite for such a complication is the turn in the middle gut and a violation of the circulation. The latter is due to the compression of the umbilical cord with the intestinal loops.
Problems may arise after surgical treatment. Basically, they are associated with dysfunction of the gastrointestinal tract. One third of children diagnosed at the age of 1.5-2 years have a developmental delay, which is easily amenable to correction.
Diagnosis
When ultrasound of the fetus gastroschisis is set after the detection of freely floating intestinal loops. With the help of an ultrasound device, it appears that there is no hernial sac, and the umbilical cord extends from the anterior abdominal wall. Sometimes a diagnosis is not made immediately. This is due to the fact that doctors take the intestinal loops for the umbilical cord.
Photo of ultrasound with gastroschisis in fetus
To reduce the probability of misdiagnosis, color Doppler scanning is used, which registers blood flow in the umbilical cord.
When a diagnosis is made, a full scan of the fetus is assigned to identify other anomalies that worsen the prognosis.
The first time the diagnosis is set at 13-14 weeks of pregnancy. An indirect sign is an increase in the level of alpha-protein in the blood of a pregnant woman. Postnatal diagnosis is performed by visual examination.
Treatment of
Treatment is possible only by surgery. The operation is performed during the first hours of the child's life. The fallen singers put in place, and the hole is sewn up.
Immediately after cesarean section, intestinal wrapping is performed using sterile materials. A nasal probe is immediately installed for decompression. Sometimes the operation is postponed, but rarely longer than 3 days.
It is believed that every 120 minutes of delay increase the risk of death of a newborn.
If the primary plastic is carried out, then an immediate immersion of the intestine takes place with correction of the defect by the tissues of the child. The disadvantages of this method include increased intra-abdominal pressure. This often causes complications, including cardiac or renal failure.
Because of the risks, surgeons often use delayed plastic surgery. For this, additional materials are used that form the extra-abdominal sac. There is a gradual immersion of the fallen organ with an accurate displacement of other organs.
Biological or synthetic implants are used. Sell and ready-made bags, which serve as a temporary cavity for the intestines.
Reviews for the treatment of
Many parents are intimidated by the analysis. But doctors do not insist on interrupting the disease, unless other serious anomalies in development are revealed. The operation is usually performed after the child is withdrawn from shock and diuresis is restored.
Many note that the diameter of the hole with the course of pregnancy decreases, but this is typical for early pregnancy. In this case, it is considered that the defect is one of the most treatable.
Prognosis for life and prevention
With timely surgical treatment, the prognosis for life is favorable, since the survival rate is 90%.Many parents, faced with such a problem, note: the child develops the same way as other children.
The probability of a favorable outcome and the further condition of the child depends on the degree of intestinal damage and the presence of concomitant diseases. For control, the baby is put on dispensary records.
Prevention includes the refusal of the mother from smoking, alcohol and drugs. It is necessary to plan the pregnancy correctly, to monitor your diet. It is important during pregnancy not to use to treat medicines with teratogenic effect, be sure to consume folic acid.
Video about the gastroschisis: