Re: GASTROSCHISIS

Posted By HFHSM.D.-bb on April 15, 1998 at 22:08:46:

In Reply to: GASTROSCHISIS posted by Angela on April 02, 1998 at 16:27:36:






I have a 5 yr. old son who was born with gastroschisis.  The diagnosis
was made at 17 wks gestation and through aminocentesis was found to
not be chromosomal.  Delivery was 6 wks early and he weighed 5 lbs 11oz
and had a primary closure.  My concern, of course, has always been to
future problem arising throughout his life and whether or not anyone
would be able to connect or pick up on the signals.  He has always
had a very difficult time having bowel movements.  He screams and
cries and when he does have one it usually is not, I guess, a good one...
hard little pieces.  He has been put on different medicines to help
soften, however, this does not seem to help.  He often complains of
severe stomach pains and then they are gone.  Is he exhibiting signs
of complications and/or is difficult bowel movements related to the
gastroschisis?
I read one of your replies to a lady about her daughter and I was very
interested in what you had to say.  Fortunately for us and him his
doctor constructed a belly button at birth, therefore all he knows
is that he has an outy with a scar.
Please reply!
Thanks a bunch!
Angela



_
April 13, 1998
Re: Gastroschisis
Dear Angela:
In reply to your letter of April 2, 1998, it is important to re-emphasize that very few children
who have had surgical repair of  gastroschisis in infancy will experience any disease or
complication as a direct consequence of this problem.  Once the vigil of the pediatric surgeon is completed, the children tend to do remarkably well.  There is always a concern about residual scarring of the intestine, but in fact the pediatric surgeon will fashion the corrective operations to minimize such risk.  Also, it is routine to examine each infant for other birth defects prior to discharge from the surgeons care.
The abdominal pain that your child is experiencing with bowel movements and the fact the the movements are small, hard, and infrequent indicate constipation.  This constellation of symptoms is
probably the most common reason for referral of children of your sons age to a pediatric intestinal specialist.  It is most likely that your son has this common childhood variety of bowel complaint
rather than a disordered bowel motility or obstruction due to the original gastroschisis.  More specifically,
the bowel after gastroschisis is not chemically or biologically altered to make it more susceptible to
diseases.  Secondly, the symptoms you describe are not likely due to a segment of partially blocked bowel
or other obstruction.  Since, however, any abdominal surgery may result in a kinked or adherent piece of
bowel, it is important that your childs surgeon reassure you that there is no such complication is present.  
It will become common for you to naturally assume that any abdominal complaint that your son
experiences is a direct consequence of or is related to gastroschisis.  Your pediatrician or pediatric
gastroenterologist who knows your child (and his intestine!) best can prospectively evaluate him and guide
his care.  The current complaints of bursts of belly pain with small stools may seem like a blockage,
but may be diet related.  There may be a confounding second problem such as lactose intolerance or
other dietary issue.  Your physician tmust exclude other causes of abdominal pain and constipation before treatment for constipation can commence.  This treatment will include dietary changes and  a stool softener,
One potential consequence of your concern regarding your sons health is a worsening of his own fears . Emotional development may be affected.  It is essential for you and your son that the problem "comes out of the dark" and that he gains comfort and confidence with the daily activity of bowel movements.  Reassurance is very important.  Becoming less self conscious will help this overall problem. Your physician may arrange psychological/moral support with a positive modification of behavior.  These measures may be needed for a long time.  
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by a physician.
W would be happy to meet you personally in order to better characterize the cause of your symptoms and to provide reassurance. If you wish to be seen by a gastroenterologist of the Henry Ford Health System, please call [phone] and request consultation with Dr. William Belknap, one of our pediatric gastroenterologists.
HFHSM.D.-bb
*keywords: gastroschisis, intestinal obstructioon, constipation, pediatric
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