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Wall Defects
Omphalocele vs.
Gastroschisis
Definition
Gastroschisis Omphlocele
Defect of the Herniation of the
anterior abdominal abdominal contents
wall in which the through the
viscera extrudes and umbilical ring,
is not covered by covered by a sac
amnion or a with an outer layer
peritoneal of amnion and and
membrane inner layer of
peritoneum.
Epidemiology
Gastroschisis Omphalocele
Incidence 1 per 6,000 Incidence 1 per 2500
M:F 1.5:1
M:F 1:1 70% or more association with
10-15% association congenital anomalies (cardiac,
GI, CNS, musculoskeletal,
with congenital genitourinary)
anomalies like Trisomies 13, 18,21.
CHD(VSD), cleft CHARGE (coloboma, heart,
palate and intestinal atresia choanae, retardation,
genitourinary, and ear
atresia
abnormalities)
40% are premature or Beckwith-
SGA Wiedemann( gigantism,
hemihypertophy, macroglossia_
Pathogenisis
Gastroschisis Omphalocele
Several hypotheses
Failure of the
Failure of the mesoderm to
form the body wall
lateral folds to
Rupture of the amnion around migrate and fuse
the umbilical ring appropriately at the
Abnormal involution of the umbilical ring,
right umbilical vein leading to resulting in
weakening of the body wall continued
Disruption of the right vitelline herniation of the
artery with subsequent body midgut.
wall damage
Abnormal folding of the body
wall resulting in a ventral
body wall defect
Risk Factors
Gastroschisis Omphalocele
Young maternal Increased
age <20 maternal age,
Low gravida Twin gestation
Prematurity High gravida
Low birth-weight Obesity
Diagnosis
Alpha-feto-protein: synthesized in the fetal liver and
excreted with fetal kidneys crosses the placenta by 12
weeks
Elevated alpha-fetoprotein on maternal triple-screen
evaluation.
Also associated with neural tube defects, duodenal or
esophageal atresia
Sensitivity is higher for gastroschisis.
40% false positive rate.