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Gastroschisis With Liver Herniation: Facts And Challenges - Abstract

Elena Tarca, Bogdan Savu, Sandu Gabriel Aprodu, Dan George Gotia, Sebastian Ionescu




Introduction: Gastroschisis is a congenital malformation in which the abdominal contents freely protrude through a defect involving all the anatomic layers of the anterior abdominal wall, most often to the right of the umbilical cord, which is normally inserted and formed. The small intestine, a large part of the colon, sometimes parts of the stomach, duodenum, fallopian tube and uterine horn, ovary or undescended testis, or the bladder apex usually stick out. Liver herniation has been extremely rare, and therefore some authors argue that these cases are actually ruptured omphalocele cases.


Material and methods: We conducted a retrospective study of 114 cases of gastroschisis treated in the Pediatric Surgery Department of “Sfanta Maria” Emergency Children’s Hospital of Iasi over a period of 23 years, namely between 1990 and 2012.


Results: According to Molik’s classification, 24 of these cases were complex, whereas the other 90 patients only suffered from simple gastroschisis. Four of them had gastroschisis with liver herniation (3.5%), three of whom only had the left liver lobe protruding and the fourth had the entire liver sticking out. Although the degree of visceral-abdominal disproportion was considerable and the cases were obviously complex (all the patients died), since no intestinal atresia or perforations were associated, according to Molik’s classification, they were included in the simple gastroschisis group, thus increasing the mortality rate in this group. The mortality rate in the complex gastroschisis group was 66.7%, and the patients’ death occurred 15.33 days later, on the average, as compared to a mortality rate of 71.1% in the simple gastroschisis group, with the patients’ death occurring after 12.75 days, on the average.


Conclusions: We suggest that Molik’s classification be changed to also include gastroschisis with liver herniation among the complex gastroschisis cases, due to the undeniable visceral-abdominal disproportion, to the difficult integration of the protruding organs and to the patients’ guarded prognosis.


Key words: complex gastroschisis, liver, classification, mortality.