A new concept for the origin of gastrochisis

Excerpt

Moore and Stokes [1] first described the individual concept of gastroschisis (GS) among other congenital anomalies of the abdominal wall in 1953, and described its typical findings as follows: (1) the umbilical cord was normal, (2) the abdominal wall defect was located away from and lateral (mostly right-sided) to the umbilicus, and (3) the abdominal defect had no sac or remnant tissue. Several other concepts have been reported thus far regarding the origin of gastroschisis [2‐7], including one denying the concept of Moor and Stokes as a myth [3], but no theory concerning the origin of gastroschisis has been established. Moore and Stokes [1] hypothesized that the anterior abdominal wall is formed by ventral extension of lower thoracic and upper lumbar myotomes, and that the defect of GS may arise from distortion or arrest of this process. Duhamel [2] later proposed that the development of GS is caused by failure of the differentiation of the embryonic mesenchyme, which forms the framework of the somatopleure, whose ectoblastic layer will be resorbed, leading to the creation of the full thickness defect of the abdominal wall. Thomas [4] stated that GS is probably the end result of the intra-uterine rupture of an incarcerated hernia into the cord. deVries et al. [5] proposed that human embryos in the early stage of development have large right and left umbilical veins which drain not only the developing placenta, but also the body stalk and evolving abdominal wall, and hypothesized that the premature and delayed loss of the right umbilical vein that nourishes the ventral abdominal wall causes GS. Hoyme et al. [6], on the other hand, suggested that gastroschisis results from an intrauterine interruption of the right vitelline artery that causes a right-sided abdominal defect. However, it has been shown that the right vitelline artery does not supply the anterior abdominal wall [7]. We herein advocate a new concept for gastroschisis based on our detailed observations, with a focus on the umbilical skin. …