Madhukar Rainbow Children Hospital, Malviya Nagar, New Delhi
+91 7678303737
consult@pediatricsurgery.in

Anterior abdominal wall Defect (Gastroschisis & Exomphalos/Omphalocele)

Dr Shandip Kumar Sinha - Paediatric Surgeon,Paediatric Urologist and Paediatric Laparoscopic Surgeon

What is this disease?

An abdominal wall defect is a term used for two conditions: Gastroschisis and Exomphalos. These occur when a baby’s abdomen does not develop fully in the womb, and are generally identified at your 20 week anomaly scan. Gastroschisis is a defect of the actual abdominal wall, which causes the bowel to protrude. In gastroschisis, the bowel is not protected by any membrane or sac. Exomphalos, however, is a defect which occurs at the base of the umbilical cord. In exomphalos, the bowel is protected by the membrane surrounding the umbilical cord.

How it is diagnosed?

It is diagnosed by clinical examination after birth. However, most of these newborns can be diagnosed by antenatal scans also.

 How it is treated?

With both gastroschisis and exomphalos, surgery may be required to repair the defect. However , both needs Neonatal care in an NICU.

When it should be operated?

The decision to operate will depend upon clinical condition of child. However, early surgery is done in Gastroschisis, as the intestine is not covered by sac whereas omphalocele surgery can be done in more controlled situation.

Are there other alternative methods of treatment?

These newborns need both Medical and surgical management in NICU. Many of these,especially, Gastroschisis, need parental nutrition for long period by central line.

What all I need to know before my child surgery?

Read “All you need to know before your child’s surgery” information booklet in website.

How is the surgery done?

Gastroschisis- If the defect is small and abdominal cavity is of appropriate size, it may be possible to put the bowel back into the abdomen and close the muscle and skin soon after birth. However, most of the newborns require a staged approach in which something called a ‘silo’ may be used. A silo is a specially designed bag which covers and protects the bowel. The bowel is  then be gradually ‘tucked’ back into the abdomen until the intestine is completely back in place. This can take several days. Once this is done, the bag is removed and the hole from which the bowel came through is closed. This can be done in the ward by applying a dressing over the hole, or in  operating theater in  final stage.

Exomphalos – With large exomphalos, we are likely to apply a special cream and wait for the skin to grow in order to cover the defect. The time that this will take will depend on the size of the defect. Once there has been enough growth, the surgeons will repair the defect completely. For smaller defect , early surgery can be done.

Remarks

For more details of surgery, contact your surgeon

Related Photographs and videos

Few photographs of steps done by me  is given here for learning purposes