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ABDOMINAL WALL DEFECTS. Dr. Catherine B. Canete. OMPHALOCOELE. Anterior abdominal wall defect at the base of the umbilical cord with herniation of the umbilical contents. Incidence. Small omphalocoele 1:5000 Large omphalocoele 1:10000 Male to female ratio 1:1

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abdominal wall defects

ABDOMINAL WALL DEFECTS

Dr. Catherine B. Canete

omphalocoele
OMPHALOCOELE
  • Anterior abdominal wall defect at the base of the umbilical cord with herniation of the umbilical contents
incidence
Incidence
  • Small omphalocoele 1:5000
  • Large omphalocoele 1:10000
  • Male to female ratio 1:1
  • Pacific Islanders have low risk for omphalocoele
pathophysiology
Pathophysiology
  • Failure of the midgut to return to abdomen by the 10th week of gestation
clinical findings
Clinical Findings
  • Covered clinical defect of the umbilical ring
  • Defect may vary from 2-10 cm
  • Sac is composed of amnion, Wharton’s jelly and peritoneum
slide8
50% have accompanying liver, spleen, testes/ovary
  • >50% have associated defects
  • Location:
    • Epigastric
    • Central
    • Hypogastric
  • Cord attachment is on the sac
gastroschisis
GASTROSCHISIS
  • Defect of the anterior abdominal wall just lateral to the umbilicus
incidence1
Incidence
  • 1:20,000-30,000
  • Sex ratio 1:1
  • 10-15% have associated anomalies
  • 40% are premature/SGA
pathophysiology1
Pathophysiology
  • Abnormal involution of right umbilical vein
  • Rupture of a small omphalocoele
  • Failure of migration and fusion of the lateral folds of the embryonic disc on the 3rd-4th week of gestation
slide13
Lateral folds
  • Form
    • Lateral abdominal wall
    • Future umbilical ring
clinical findings1
Clinical Findings
  • Defect to the right of an intact umbilical cord allowing extrusion of abdominal content
  • Opening  5 cm
  • No covering sac
slide16
Bowels often thickened, matted and edematous
  • 10-15% with intestinal atresia
management
MANAGEMENT
  • ABC
  • Heat Management
    • Sterile wrap or sterile bowel bag
    • Radiant warmer
  • Fluid Management
    • IV bolus 20 ml/kg LR/NS
    • D10¼NS 2-3 maintenance rate
slide19
Nutrition
    • NPO and TPN
  • Gastric Distention
    • OG/NG tube
  • Infection Control
    • Ampicillin and Gentamicin
  • Associated Defects
slide20
Conservative treatment
    • Reduction by squeezing the sac
    • Painting sac with escharotic agent
      • 0.25% Silver nitrate
      • 0.25% Merbromin (Mercurochrome)
slide22
Surgical Management
    • Skin Flaps
    • Primary Closure
    • Staged Closure
      • Staged repair using silo pouch
umbilical hernia
UMBILICAL HERNIA
  • Defect in linea alba, subcutaneous tissue and skin covering the protruding bowel
  • Frequent in premature infants
prune belly syndrome
PRUNE BELLY SYNDROME
  • Thin, flaccid abdominal wall
  • Dilation of bladder, ureter and renal collecting system
  • 1:30,000-50,000
  • 95% are male
bladder extrophy
BLADDER EXTROPHY
  • Defective enfolding of caudal folds
  • 3.3 in 100,000 births
  • Associated with prolapsed vagina or rectum, epispadias, bifid clitoris or penis
pentalogy of cantrell
PENTALOGY OF CANTRELL
  • Omphalocoele
  • Anterior diaphragmatic hernia
  • Sternal cleft
  • Ectopia Cordis
  • Intracardiac defect
beckwith wiedemann syndrome
BECKWITH-WIEDEMANN SYNDROME
  • Macrosomia
  • Macroglossia
  • Organomegaly
  • Abdominal wall defects
  • Embryonal tumors