Abdominal wall defects

Question 1

What are the different congenital abdominal wall defects

Answer 1

Gastroschisis
Omphalocele
Bladder extrophy
Cloacal extrophy

Question 2

What is gastroschisis

Answer 2

It is a full thickness defect of the abdominal wall usually located to the right of the normal umbilical cord

It is a medical emergency - bowel outside o fthe body

Question 3

What is the emergency treatment for gastroschisis

Answer 3

Confirm airway, breathing, heartbeat

Drip
Incubator
NG tube free drainage
Examine opening and bowel: look fo rstrangulation
Cover bowel with plastic
Position of right side
Prep for transport to pediatric surgeon

Question 4

What does the acronym TWO SIDES stand for

Answer 4

Trans port of neonate

T- Tubes
W - Warmth
O- Oxygen
S - Stabilise
I- IV fluids
D - Documents
E - Escort
S - Specimens

Question 5

What is the peadiatric surgeon treatment for gastroschisis

Answer 5

Reduction of bowel and primary closure of abdominal wall defect
- ICU with ventilation to prevent splintng of diaphragm and abdominal compartment syndrome
If not possible silo and delayed closure defect

Question 6

What are the long term outcomes of gastroschisis

Answer 6

50% mortality due to
- Insufficient resus, long transport

Severe bowel loss - Short bowel syndrome
- due to extensive bowel necrosis during gestatio

Question 7

What is Omphalocoele

Answer 7

Congenital abdominal wall defect at the umbilical ring

Evisceration of internal organs in a sac covered by a 3 layered membrane - Peritoneum, Whartons jelly, Amnion

Failure of bowel loops to return to abdominal cavity between 6-10th week

Question 8

What are the associated malformations with omphalocoele

Answer 8

VACTERL association
Genetic abnormalities
Beckwith-Wiedemann syndrome
- Macrosomia
- Macroglossia
- Prone to hypoglycaemia

Question 9

What are the initial treatments for Omphalocoele

Answer 9

Intact memebrane
- Drip
- NG tube free drainage
- Treat omphalocoele sace with antiseptic
- Cover with gause and crepe bandage
- refer to pediatric surgeon

Ruptured membrane
- Treat as gastroschisis

Question 10

What are the pediatric treatment for omphalocoele

Answer 10

Small omphalocoele - Primary closure at tertiary hospital

Giant omphalocoele - conservative treatment
- Sac covered with antiseptic untill fully epithelialized

Question 11

What are the long term outcomes of Omphlocoeles

Answer 11

Small omphalocoeles
- No long term side effects

Large omphalocoeles:
- GORD
- Feeding difficulty and failure to thrive

Midgut volvulus
Cosmesis
Beckwith-Wiedemann at risk