03.08 Abdominal Wall Defects Flashcards
Embryo forms four folds that will enclose the body cavities
4th week
Rapit intestinal and liver growth
herniation of midgut into the umbilical cords
Presence of umbilical ceolom
6th week
Midgut returns to the abdominal cavity
10th week
Failure of the viscera to result to the abdominal cavity
Omphalocoele
Failure of lateral fold to develop
Failure of the umbilical coelom to develop
The intestines rupture out of the body wall at the area of the resorbed right umbilical vein
Gastroschisis
Gastroschisis is diagnosed thru ____ by ____
Prenatal ultrasound
20 weeks AOG
Elevated maternal AFP No sac Smaller than omphalocele Midgut Born to mothers younger than 21 Preterm delivery
Gastroschisis
Most common associated anomalies of gastroschisis
Intestinal atresia
Managment of gastroschisis
Early delivery
Neonatal resuscitation and management
Surgery
Primary goal is to return the viscera to the abdominal cavity while minimizing the risk of damage to the viscera
Surgery
Surgical options
Primary closure
Staged
Post-op syndrome when the abdomnial cavity might not be able to handle the sudden increase in volume
Abdominal compartment syndrome
Bowels are returned to the abdominal cavity
Fascia and skin are closed
Primary closure
Complications of primary closure
Abdominal distention
Abdominal compartment syndrome
Can be done bedside without general anesthesia
Makes use of silastic sheets sewn together and sutured to the abdominal wall or a preformed silo with a circular spring
Staged closure or SILO
Prevents high intraabdominal pressure and allows early extubation
Staged closure
Avoids septic complication of having a foreign body
Primary closure
Central abdominal wall defect under umbilical cord
Usually larger than 4 cm in diameter
Always covered by a translucent sac from which the umbilicus extends
Full term
Omphalocele
Most common associated anomalies of omphalocele
Cardiac anomaly (VSD, ASD)
Syndromes associated with omphalocele
Edwards Syndrome (Trisomy 18) Beckwith-Wiedemann Syndrome OEIS (omphalocele, exstrophy of the bladder, imperforate anus, spinal anomalies) syndome Pentalogy of Cantrell Cloacal Exstrophy
Cephalic fold defect
Pentalogy of Cantrell
Five characteristic findings of pentalogy of Cantrell
Omphalocele Anterior diaphragmatic hernia Sternal cleft Ectopia cordis Intracardiac defect
Claustral fold defect
Infraumbilical defect
No spinal deformities
Cloacal exstrophy
Management of omphalocele
Perinatal care
Neonatal resuscitation and management
Surgical management
Indications of surgery for omphalocele
> 10 cm
Gestational age
Presence of associated anomalies
Defect is small
Sac is excised
Primary closure
Escharotic therapy
Staged closure
Scarificant and disinfectant for staged closure
Silver sulfadiazine
Iodine
Umbilicus is intact but there are segments of the bowels going out
Hernia of the umbilical cord
Fascial defecct at the umbilicus Covered by skin Does not require surgery Persistence of umbilical ring Will close spontaneously by 3-4 years old
Umbilical hernia
