Direct Peritoneal Resuscitation in Gastroschisis

Gastroschisis is a clinical condition characterized by a defect in the normal development of
the abdominal wall. The defect is present to the right of the umbilicus leading to in utero
bowel evisceration and exposure to amniotic fluid. Prolonged exposure to amniotic fluid may
lead to inflammatory changes and damage to the exteriorized bowel. After birth and prior to
operation, the usual treatment consists of covering the bowel with impermeable plastic bag to
prevent additional fluid losses and bowel desiccation. Subsequent operative intervention
occurs either in the operating room or in the neonatal intensive care unit. Two surgical
options include primary closure of the abdomen or placement of a silastic silo followed by
subsequent closure several days later as a staged procedure. The main reason the abdominal
wall is not closed initially is due to fear of abdominal compartment syndrome, a condition
caused by high intra-abdominal pressures leading to respiratory and circulatory compromise.
The key points of the initial surgery involve examining the intestine for any signs of
atresia, bowel compromise, and either placement of the bowels back into the abdomen or a
spring loaded silo.