A comparative investigation of the bowel wall in gastroschisis and omphalocele: relation to postoperative complications.

In gastroschisis the protruding bowel is generally covered by a fibrous coating as a result of prolonged exposure to amniotic fluid but no such coating is found on the exposed bowel loops in a ruptured omphalocele. In patients with gastroschisis, the postoperative course is often complicated by periods of hypoperistalsis. Based on studies of animal models of gastroschisis, various authors have suggested that the postoperative complications might be due to structural defects of the bowel wall. In our own experimental investigation of gastroschisis using chick embryos, we found no evidence of a structural defect of the bowel wall. With a view to clinical substantiation of our experimental findings, we conducted a comparative investigation of patients material, involving 10 cases of gastroschisis, 5 cases of ruptured omphalocele, and 9 cases of intact omphalocele. The investigation revealed an entirely normal structure of the bowel wall in all 10 cases of gastroschisis. On the serosa we noted an inflammation infiltrate rich in collagen fibers, frequently containing squamous cells (vernix) and lanugo. In the cases of ruptured omphalocele, the bowel wall specimens revealed a subacute inflammatory reaction. No major abnormalities were found in the bowel wall of patients with an intact omphalocele. Normal development of the autonomic nervous system was found in all patient material. Severe ischemic changes of the bowel wall were found in 4 of the gastroschisis cases and these were the 4 patients who suffered from postoperative hypoperistalsis. Thus the complications occurring during the postoperative phase of gastroschisis are most probably due to ischemic bowel damage.