A newborn is noted to have evisceration of bowel through a full-thickness defect just to the right of the umbilicus. The exposed bowel is thickened, matted and covered with an inflammatory peel, but there is no covering membrane. Which statement is correct?

• A This is omphalocele, and the cord inserts into the apex of the sac
• B This is gastroschisis, managed with silastic silo and staged reduction if primary closure is not possible ✓
• C This is gastroschisis, associated with a higher rate of chromosomal anomalies than omphalocele
• D This is omphalocele, best treated with delayed closure after epithelialisation

Explanation

Absence of a covering membrane with a defect to the right of the umbilicus defines gastroschisis; the inflammatory peel results from amniotic fluid exposure. Management is bowel protection with a silo and staged reduction when the viscera cannot be returned primarily. Gastroschisis has far fewer associated chromosomal and structural anomalies than omphalocele, which kills option C. Option A is wrong because the cord does not insert into a sac here, since no sac exists.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.