title: Closing gastroschisis: diagnosis, management, and outcomes.
abstract: OBJECTIVE
  Gastroschisis (GS) is defined as a full-thickness abdominal wall defect (usually right-sided) with intestinal prolapse and occasionally other viscera. The defect itself may close around the viscera causing exit or entry level intestinal atresia and ischaemia or midgut infarction, previously described as closed GS. We now report the largest series of infants born with various stages of closing GS describing features, management, and outcome.
  
  
  METHODS
  The study used a single-centre retrospective review of infants with GS and evidence of defect closure at birth.
  
  
  RESULTS
  Nine infants (6 girls) with a median of 35 (range, 32-36) weeks of gestation fulfilled criteria for closing GS from a series of 146 (6%) infants born from August 1994 to December 2007. Delivery had been expedited in 6 based on increasing intraabdominal bowel dilatation and suspicion of closing GS on serial antenatal ultrasound. At delivery, 5 had compromised but viable bowel and required intestinal surgery. Three fetuses, all with midgut necrosis, had antenatal scans typical of GS with no additional features. After a variety of surgical procedures, 7 patients are now fully enterally fed, one is parenteral nutrition-dependent. One died of end-stage liver failure secondary to short bowel syndrome. The length of follow-up was 6 (range, 0.5-11) years.
  
  
  CONCLUSIONS
  Of infants with GS, 6% present with closing abdominal ring. Close antenatal monitoring may prevent severe bowel loss in some cases. After multiple surgical interventions, most have a favorable outcome.
authors.affiliation: Department of Paediatric Surgery, King's College Hospital, London, United Kingdom. chhouben@web.de
authors.forename: Chris
authors.initials: C
authors.lastname: Houben
authors.forename: Mark
authors.initials: M
authors.lastname: Davenport
authors.forename: Niyi
authors.initials: N
authors.lastname: Ade-Ajayi
authors.forename: Nicki
authors.initials: N
authors.lastname: Flack
authors.forename: Shailesh
authors.initials: S
authors.lastname: Patel
mesh_terms: D005260:Female; D020139:Gastroschisis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies