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Abdominal wall defects – Gastroschisis and Exomphalos/Omphalocele

OVERVIEW

Exomphalos, which derives from the Greek language and translates to "outside the navel", is alternatively known as omphalocele. This condition is a congenital anomaly where the abdominal contents protrude through the umbilical ring and into the umbilical cord. The visceral organs, which may encompass the liver, are surrounded by a delicate membrane composed of peritoneum and amnion.

Gastroschisis, which can be translated to "stomach cleft" in medical terminology, is a type of congenital anomaly affecting the abdominal wall. Usually, it manifests on the right side of the point where the umbilical cord is attached. This condition leads to the herniation of abdominal contents into the amniotic sac, which usually includes the small intestine, and sometimes the stomach, colon, and ovaries. Unlike exomphalos, there is no covering membrane in gastroschisis.

Signs and symptoms of abdominal wall defects

The signs and symptoms of abdominal wall defects, such as gastroschisis and exomphalos, can vary depending on the severity of the condition. Some common signs and symptoms of these defects include:

Gastroschisis:

Visible bulge or protrusion of the intestines outside of the abdominal cavity
Abdominal swelling
Discomfort or pain in the abdomen
Poor feeding and growth
Premature birth

Exomphalos:

Visible bulge or protrusion of the abdominal contents through the belly button (umbilicus)
Swelling or discolouration around the belly button
Breathing difficulties
Feeding difficulties and poor weight gain
Abdominal distension

Treatment

Abdominal wall defects like gastroschisis and exomphalos are typically diagnosed before birth during routine prenatal ultrasounds, and infants with these defects may require surgical intervention shortly after birth to correct the issue.

In gastroschisis, surgical repair is usually done shortly after birth. The exposed abdominal organs are carefully placed back into the abdomen, and the defect in the abdominal wall is closed. Sometimes, a temporary silo bag is used to gradually reduce the size of the defect, allowing the abdominal contents to be returned slowly. The infant may require total parenteral nutrition (TPN), a form of intravenous nutrition until the bowel function returns to normal.

In exomphalos, the surgical repair may also be performed shortly after birth. The surgeon carefully places the abdominal organs back into the abdomen and closes the opening in the abdominal wall. If the defect is large, the surgeon may use a synthetic mesh to reinforce the abdominal wall. The infant may also require TPN until the bowel function returns to normal.

The surgical repair of these defects is typically successful, and most infants recover well after the procedure. Infants with these conditions may need close monitoring in the neonatal intensive care unit (NICU) until they can tolerate feedings and have normal bowel function.

REQUEST A CONSULTATION

Dr Mangray, the founder of KZN Specialised Paediatric Surgical Service, and his associates, Dr Ngobese, Dr Govender and Dr Dube-Zvirikuzhe, have a well-established reputation for caring for children right until late adolescence.

FREQUENTLY ASKED QUESTIONS

FAQ

1What causes gastroschisis and exomphalos?

Abdominal wall defects like gastroschisis and exomphalos occur during foetal development when the abdominal wall doesn't form properly. The exact cause is not known, but genetics and environmental factors may play a role.

2Can abdominal wall defects be treated before birth?

No, abdominal wall defects cannot be treated before birth. However, the baby's condition can be monitored closely, and delivery can be planned at a hospital with a neonatal intensive care unit (NICU) and a paediatric surgeon on staff.

3Can abdominal wall defects be prevented?

There is no known way to prevent abdominal wall defects. However, pregnant women can take steps to promote a healthy pregnancy, such as getting early and regular prenatal care, eating a healthy diet, avoiding alcohol and tobacco, and taking prenatal vitamins.