Abdominal Wall Defects, Pediatric

• • Gastroschisis: Associated with other abnormalities 10% of time, most often intestinal atresia, associated with preterm infants

  • Omphalocele: Associated with other abnormalities 50% of time, nearly always full-term infants

Epidemiology

• • Gastroschisis: 1/3000-1/8000 births

  • Omphalocele 1/6000-1/10,000 births

Symptoms and Signs

• • Gastroschisis nearly always located to right of umbilicus, inflamed bowel and foreshortened mesentery secondary to exposure to amniotic fluid

  • Umbilical cord part of sac in omphalocele along with peritoneum

Imaging Findings

• • Abdominal wall defect often noted with prenatal US

• • Associated congenital abnormalities, especially intestinal atresia with gastroschisis

Rule Out

• • Intestinal atresia with gastroschisis

• • History and physical exam

  • Chest film

  • Echocardiogram (for omphalocele)

  • Renal US (for omphalocele)

  • CBC

  • Metabolic panel

Surgery

• • Primary repair possible in 60-70%

  • Silastic pouch or silo construction followed by gradual reefing and eventual closure

  • Giant omphaloceles: Nonoperative initial therapy, gradual epithelialization, and closure months to years later

Medications

• • Total parenteral nutrition during resolution of ileus

Complications

• • Abdominal compartment syndrome

  • Necrotizing enterocolitis (15% in gastroschisis)

  • Delayed ileus or intestinal dysmotility (especially in gastroschisis)

References