By William J. Cochran, MD, Geisinger Clinic
Last full review/revision August 2019 by William J. Cochran, MD
In
abdominal wall defects, the muscles surrounding the abdominal cavity
are weak or develop holes, allowing the intestines to spill out.
The two main abdominal wall defects are omphalocele and gastroschisis.
Omphalocele
An omphalocele is caused by an opening (defect) in the middle of
the abdominal wall at the bellybutton (umbilicus). The skin, muscle, and
fibrous tissue are missing. The intestines spill (herniate) out through
the opening and are covered by a thin sac. The umbilical cord is in the
center of the defect.
An omphalocele commonly occurs along with other birth defects (such as heart defects and kidney defects) and with specific genetic syndromes (such as Down syndrome, trisomy 18, and trisomy 13).
Gastroschisis
Gastroschisis also is an abnormal opening of the abdominal wall. In gastroschisis, the opening is near
the bellybutton (usually to the right) but not directly over it, like
in omphalocele. Like in omphalocele, the opening allows the intestines
to spill out but unlike omphalocele, the intestines are not covered by a thin sac.
Before birth, because the intestines are not covered by a sac,
they may be damaged by exposure to amniotic fluid, which causes
inflammation. The inflammation irritates the intestine, which can result
in complications such as problems with movements of the digestive
system, scar tissue, and intestinal obstruction.
(See also Overview of Digestive Tract Birth Defects.)
Diagnosis
-
Blood tests
-
Usually prenatal ultrasonography
Doctors may suspect gastroschisis if the level of alpha-fetoprotein (a protein produced by the fetus) in the mother's blood is abnormally high during pregnancy.
Both omphalocele and gastroschisis are usually diagnosed before birth with routine prenatal ultrasonography. If not, the defects are very obvious as soon as the infant is delivered.
Treatment
-
Surgery
Once the infant is delivered, the exposed intestines are covered
with a sterile dressing and the infant is given fluids and antibiotics
by vein. A long, thin tube is passed through the nose and placed in the
stomach or intestine (nasogastric tube) to drain digestive fluid that
collects in the stomach.
Surgery is required to replace the intestines in the abdomen and
close the opening. However, the skin of the abdominal wall often must be
stretched before surgery so there is enough tissue to cover the
opening. Large defects sometimes also require skin flaps. If a large
amount of intestine is sticking out, it may be wrapped in a protective
covering (called a silo) and gradually moved back into the abdomen over
several days or weeks. When all the intestines are back in the abdomen,
the opening is surgically closed.
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