Secondary bladder herniation in isolated gastroschisis justifies increased surveillance.
OBJECTIVE
To assess the perinatal outcome of fetuses with gastroschisis complicated by secondary bladder herniation. POPULATION AND MATERIALS: This was a retrospective study of all cases of isolated gastroschisis associated with bladder herniation managed at our institution. Prenatal ultrasound, obstetrical and perinatal information were collected. Pathology reports were also gathered.


RESULTS
Out of 105 cases of gastroschisis managed at our institution, six (5.7%) were associated with secondary bladder herniation, two of them being diagnosed postnatally. Median gestational age at diagnosis of bladder herniation was 33.6 weeks (range 31-36) in five female and one male fetuses. Bladder herniation was associated with bowel dilatation in four cases (67%) and with pyelic dilatation in one case (17%). Despite increased surveillance, one male fetus died in utero. In four other cases, cesarean section was performed for fetal distress (three cases) or hyperechogenic bowels (one case). The five survivors had primary abdominal closure (n = 2) or staged repair (n = 3) with uneventful follow-up.


CONCLUSIONS
Bladder herniation was present in 6% of apparently isolated gastroschisis. There was one intrauterine fetal death and four other cases were delivered for fetal distress. Increased surveillance seems justified.
Department of Obstetrics and Fetal Medicine, Necker-Enfants-Malades Medical School, Paris Descartes University, 149 rue de Sèvres, 75015, Paris, France.
E
E
Mousty
G E
GE
Chalouhi
A
A
El Sabbagh
N
N
Khen-Dunlop
M
M
Kuleva
L J
LJ
Salomon
Y
Y
Ville
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005315:Fetal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005323:Fetal Monitoring / Q000379:methods*; D020139:Gastroschisis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005865:Gestational Age; D006547:Hernia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D001745:Urinary Bladder Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult