Gastrointestinal congenital anomalies requiring surgery

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 5 – A N T E N ATA L C A R E

GI Congenital Anomalies Requiring Surgery: Diagnosis, Counselling & Management Mires S et al. Gastrointestinal congenital anomalies requiring surgery: diagnosis, counselling, and management. TOG 2023;25:186–195. doi:10.1111/tog.12884

6% ~10% 95.7% WHO GLOBAL CONGENITAL ANOMALY RATE OF ANOMALIES ARE GI ANTENATAL DETECTION, OMPHALOCELE

DO N' T-M IS S FA C TS

  1. Giant omphalocele = >5 cm diameter or >50% liver in sac – risk of pulmonary hypoplasia; consider ELCS to ↓dystocia/trauma

  2. Physiological gut herniation resolves by 12 weeks – scanning for omphalocele before this risks false positives

  3. Gastroschisis: usually right-sided, no peritoneal covering, normal cord insertion; omphalocele: covered, cord at apex

  4. Beckwith–Wiedemann syndrome – check neonatal blood glucose (hypoglycaemia risk, long-term neurological harm if missed)

  5. Ruptured omphalocele sac → manage as gastroschisis; associated with ↑mortality

  6. Delayed atresia repair 4–6 weeks post gastroschisis closure – reduces anastomotic leak risk

  7. TOP Ground E cut-off 24 weeks; feticide mandatory if performed beyond 21+6 weeks

  8. MDT = fetal medicine + obstetrics + paediatric surgery + neonatology – anxiety reduction independent of anomaly severity

ANTENATAL FEATURES AT A GLANCE

Omphalocele: membrane-covered, cord at apex, msAFP↑

Gastroschisis: uncovered, right of normal cord, oligohydramnios up to 25%

ABBREVIATION KEY

WHO — World Health Organization CVS — chorionic villus sampling

GI — gastrointestinal PPROM — preterm prelabour rupture of membranes

FASP — fetal anomaly screening programme ELCS — elective caesarean section

msAFP — maternal serum alpha-fetoprotein TOP — termination of pregnancy

CHD — congenital heart defect(s) BMI — body mass index

MDT — multidisciplinary team OEIS — omphalocele, exstrophy of bladder, imperforate anus, spinal defects (complex)

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — 2023;25:186–195. doi:10.1111/tog.12884

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