Malformations of the Anterior Abdominal Wall

Malformationsof the abdominalwall occur due to violations of embryogenesis of its layers and
elementsat differentstages of fetal development.
Classificationof hernias:
- on localization:
- external(omphalocele,inguinal,umbilical,femoral,of the white line of the abdomen,etc.);
- internal(diaphragmatic,pinching(incarceration)of abdominalorgansin naturalor abnormal
openingsinside of the abdominalcavity);
- on etiology:
- congenital;
- acquired (hernias of underdeveloped (weak) abdominal wall, traumatic, postoperative
ventral);
- on the conditionof the internalorgans in the hernialsac:
- free;
- reducible(hernialcontentscan be insertedwith little effort);
- irreducible;
- incarcerated(pinching);
- sliding (one of the walls of the hernialsac is the wall of the organ(most of the bladder));
- on the presenceof hernialelements:
- real(containall elementsof hernia);
- false (do not have a hernialsac).

Embryonic hernia (omphalocele) is a severe malformation,which is a defect of the anterior

abdominal wall and is accompanied by underdevelopmentof the abdominal cavity (visceral-
abdominaldisproportion).The largerhernia,the more underdevelopmentof the abdominalcavity
(smaller volume of the abdominalcavity). The frequencyis 5-6 cases per thousandbirths(Yu. f.
Isakov,1998).
Embryology:
- formedat 4-10 weeks of embryonicdevelopmentas a physiological embryonicherniacontaining
the middleintestine(midgut),butdoes not receive reversedevelopment;
- thuspartof the intestinedue to violationof its rotationremainsin the hernialsac;
- the child is bornwith a umbilicalcordhernia.
Classification:
- on size (GavryushovV. V., 1961):
- small (wall defect up to 3-4 cm in diameter,bulgingup to 5 cm in diameter);
- mediumsize (defect up to 7 cm, protrusionup to 10 cm);
- large(defect morethan7 cm, bulgingmorethan10 cm);
- on duration:
- uncomplicated(with unchangedmembranes);
- complicated (congenital eventration (intraamnioticrupture of membranes hernial sac),
intestinalfistulas, intra-natalruptureof the shells purulentinflammationof the membranes,
ectopiaof the heart,relateddefects);
- on origin:
- actually embryonic hernias (formed up to 3 months of gestation; in this case, the glisson
capsule of the liver is solderedto the membranesof the hernialsac, since duringthis period
the capsuleof the liver is formedsimultaneouslywith the membranesof the hernia);
- embryohernia(formedafter3 months.herniamembranesarenot solderedto the liver);
- mixed hernias.
Clinic:
- thereis a defect of the abdominalwall in the umbilicalregion with protrusionof internalorgans,
outside covered with a transparentgrayish shell, which consists of the same elements as the
umbilicalcord. The hernialsac passes directlyinto the skin, which on the verge with the sac has a
reddishcorollaup to 2-3 mm wide;
- the umbilical cord is located to the left of the formation;sometimes there are difficulties when
bandagingthe umbilical cord: to avoid bandagingthe hernialcontents, it is recommendedto twist
the cordfromthe peripheryto the base;
- the morehernia,the moresevere the condition;
- often combinedwith othermalformations:atresia,non-obliterationof urachus,etc.;
in small hernias,the contentsare usually insertableinto the abdominalcavity, opposite to medium
and large hernias because of developing cardio-respiratorydisorders (via visceroabdominal
imbalance),in such cases talkabouta negativetest on insertion;
Diagnostics:
- antenatalultrasound(visualized roundedformationlocated in the area of umbilical cord, placed
extracorporally);
- postnataldiagnosisis basedon examination.
Treatment:
- diagnosisis an indicationfor cesareansection;
- at birth,the shell is treatedwith 70% ethyl alcohol, then 1% iodine solution, afterwhich a sterile
bandagewith antibioticsis applied(the goal is to preservethe integrityof the hernialsac).
Surgicaltreatment:
- indications:
- uncomplicatedsmall size in the absence of infection of the membranes– in the first hours
afterbirth;
- herniawith ruptureof the herniasac andeventration;
- herniascombinedwith othermalformationsof the abdominalorgansrequiringurgentcare;
- preoperativepreparationduringabout1-2 hours:
- warmingin incubator;
- humidifiedoxygen (if necessary);
- the introductionof a gastrictubewith the removalof content;
- intravenous(central)access;
- with small andmediumhernias- one-stageoperation;
- at large- two-stageoperationby Gross,Tikhomirova,V. D., Isakov,Yu.F.:
- I-st - suturingof the skin over the hernia- ventralherniaformation;
- II-nd- plastyof aponeurosis,sometimeswith the use of allografts;
- duringsurgery,you should monitorthe pressurein the bladder(inferiorVena cava) (!): when the
pressure rises to 200 mm of water column comes compression of the renal veins, which is
accompaniedby the cessationof renalfunctionandcardiac-respiratory disorders.
Conservativetreatment:
- indications:
- herniascomplicatedby inflammationof the membranesof the hernialsac;
- herniaof largesize, which uponreductionlead to stop of breathingandcardiacactivity;
- hernias, combined with severe malformationsor diseases (severe cerebral trauma,heart
defects, deep respiratorydisorders,prematurity,etc.), which are contraindicationsfor the
operation;
- the purpose is prevention or treatment of infection with the creation of conditions for
epithelialization:
- treatmentof shells with 70% ethyl alcohol and 1% iodine solution, after drying the shells, the
procedureis repeated3-4 times a day with an intervalof 5-10 minutes;
- if the child is in couveuse – a herniais left open – if not, cover with sterile,drydressing;
- within 1-2 days, the herniais treatedevery 1.5-2 hoursuntil complete dryingand the formationof
a dense elastic crust; gradually,granulationand epithelializationbegins aroundit, the shells are
mummifiedanddisappearfor 3-5 weeks;
- after that, the wound is covered with ointment dressings with iruksol, solkoseril, Shostakovsky
balsam,andthe woundis irradiatedwith UV-rays;
- the hernialsac is epithelializedin about2-2.5 months;
- after conservative treatment,the child is operatedon at the age of about 1-5 years by plastic
surgerywith its own tissues or artificial(synthetic)nets.

Gastroschisis (from greek – “the divergence of stomach”) – intrauterineeventrationof intestine

from abdominalcavity arisingparaumbilical,most often on the right,and connectedprobablywith
the disruptionof blood supply of the fetal abdominal wall. The frequency is 1 case per 6000
newborns,40%of which arepremature.
Clinic:
- short part of the midgut falls out through the abdominal defect and is three times larger in
diameterthan the defect (due to the pinching phenomenon),can sometimes fall bladder,uterine
appendage;
- loops of the intestine from the outside are covered with fibrin coating, matte, edematous,
thickened,expanded;
- hernialsac is absent;
- can be combinedwith malformationsof intestine,CNS, kidney,heart,etc.
Diagnostics:
- antenatalultrasound,which reveals the presence of a formationwith a wavy uneven contour,
which is extracorporeal;
- clinical basedexamination.
Treatment:
- gastroschisis is an indicationfor plannedcesareansection upon the completion of 36 weeks of
gestation;
- after birth-anesthesiawith central analgesics (morphine0.1-0.2 mg/kg, fentanyl 20 mg/kg per
hour,etc.));
- loops of intestinescover with dampwarmnapkins,then put them in a sterile polyethylenebag or
cover themwith the processedamnioticcovers takenduringchildbirth;the purposeis to preventthe
overcoolingandinfection;a bag is suspendedverticallythatblood supplyin a gut was not broken;
- establishmentof the gastricprobefollowed by aspiration;
- transfer to neonatal resuscitation for the removal of the newborn from perinatal shock and
preoperativepreparation;
- after1-2 days – surgery:
- one-stage- when viscero-abdominaldisproportionof I degree;
- two-stage (I-st – the formationof a ventralherniaby covering of the content with pre-separated
skin or synthetic absorbablepolymers (Silastik silo), or tutoplast-pericardium;II-nd – after 6-14
days – relaparotomy,separation of adhesions between loops, correction of associated defects,
possible gastrostomywith intubationof the intestine).
The operationis carriedout underthe control of pressurein the superiorvena cava (not above 20
mm Hg) (indirectmethods – diuresis control or measurementof intravesicalpressure).Currently,
due to the appearanceof syntheticand artificialmaterials(Tutoplast-pericardium, its own amniotic
membraneafterits treatment,polypropylenemesh / bags, etc.) it is possible to carryout a full-layer
plastic of the abdominalwall without the formationof a ventral hernia, which reduces surgical
traumaandpreventsvisceroabdominaldisproportion.
In the early postoperativeperiod:
- extendedmechanicalventilation;
- thermoregulationsupport;
- prolongeddecompressionof the stomach;
- adequateparenteralnutrition;
- intensivecare.
The modernmethodof correction– intraamnioticinterventionin the fetus (endoscopic clipping of
the abdominalwall defect afterbowel reductionin the 2nd trimesterof pregnancy).In this case, the
child is bornhealthy.
Umbilical hernia is up to 30% of all herniasin children,observedmore often in infancy, 2-3 times
moreoften amonggirls.
Embryology:
- the umbilical ring closes after the umbilical cord remainsfall off, the final closure occurs at the
6th monthof life;
- protrusionoften occurs in the uppersemicircle of the navel, because it is weaker,it's contributed
by the increasingof intra-abdominalpressure(constipation,crying,etc);
- the hernialsac is locateddirectlyunderthe skin andis often solderedto it.
Clinic:
- protrusionin the navel area that appears / increases because of vertical position, screaming,
coughing,crying,tension.
Complicationsoccurextremelyrare:incarceration,ruptureof thinnedhernialwall (1 reportedcase).
Treatment:
- conservative:puttingthe child on the abdomen(3-5 minutes to 5 times a day for 20-30 minutes
beforefeeding), abdominalwall massageandnavel area.
- surgical:with very large hernias(very rare)– surgeryafter6 months– 1 year of age. More often
operateafter2-4 years.Methods:
- by Lexer . ;
- by Mayo.;
- by Spitz.

Pathology of the vaginal process occurs due to a violation of its formationor reversedevelopment
(obliteration)when the testicles areloweredinto the scrotum.
Embryology:
- it is known that the gonads have the common origin with the kidneys, which is formed in the
region of the posterior surface of the abdominal cavity, and after separation at the stage of
pronephrosat the 7th week of gestation, they graduallyfall in the direction of the deep inguinal
rings,which the testicles reachat the 32nd week;
- then, in the process of passing of the testicles through the inguinalcanals, the parietalperitoneum
is "pushed"by theminside canals,formingthe vaginalprocessesthemselves;
- right-sidedlocalization of the pathology of the vaginal process occurs in more than 50% of all
cases;
- in girls, vaginal processes are formed when the roundligaments of the uterusgerminatethrough
the inguinal canals, so they also may have a pathology of vaginal processes (female hydrocele
(Nuck'scyst) andinguinalhernia).
The need to find the testicles in the scrotumis primarilydue to the fact thatthe permeabilityof the
hematotesticularbarrier(the wall of the seminiferous tubules, Sertoli cells, vascular wall), the
presenceof which is due to the antigenicpropertiesof the spermatogenicepithelium,is disturbedat
a temperaturethat is in the abdominalcavity. This explains the mechanism of complications of
violation of lowering of the testicle / testicles into the scrotum.If they are undescendedbefore the
age of 5 years,the following changesarenoted:
- irregularshapeof the tubules;
- histologicalsymptom" Sertolicells only”;
- in the futurecollagen closes the lumenof the tubules,thatleads to atrophy.
Cryptorchidism is a pathologicalcondition that occurs when the testicle is not in the scrotum.It
happensone-and bilateral,inguinal (more often) and abdominal.Often accompaniedby a more or
less pronouncedhypoplasiaof the testis.
Reasons:
- functional(hormonalimbalanceof the motherduringpregnancy,prematurity,immaturityof the
fetus);
- organic(shortening,rigidityof the vaginalprocess,shortspermaticcord).
Clinic:
- absenceof testis/testesin the scrotum;
- hypotrophyof the correspondinghalf of the scrotumwith the displacementof the median seam
towardsthe lesion; flatteningof the entirescrotumwith bilaterallesion;
- palpabletesticle in the projectionof the inguinalcanal(with inguinalcryptorchidism).
Diagnostics:
- ultrasoundof the inguinalareasandthe kidneys;
- radioscintigraphy;
- CT, MRI;
- surgicalrevision(laparoscopicor open).
Differentialdiagnosis:
- pseudocryptorchidismis a consequence of enhanced cremasteric reflex (it's normal), the
developmentof the scrotumis normalin such cases;
- monorchidismandanorchidism(no originof testicle/testicles);
- inguinalhernia(cryptorchidismcan be combinedwith it);
- ectopia of the testicle (abnormal (femoral, perineal, pubic, iliac, criss-cross) subcutaneous
placementof the testicle/testicles, which got out of the inguinal canal, but weren'tincluded in the
correspondinghalf of the scrotum).
Treatment is surgical. The optimal term for the operation is 6-18 months. Main points of
intervention:
- inguinaltransverseaccess with opening of the anteriorwall of the inguinalcanal and its revision;
when abdominalform-openingof the posteriorwall of the canalin the regionof the deep ring;
- mobilization of the testicle with the release of the vaginal process from the elements of the
spermaticcord, ligation of the base of the process with its intersection;the main adhesionsand the
vaginal process are located near the deep inguinal ring; if it is good to mobilize the testis, the
spermaticcordis extendedby 1.5 cm;
- to extend the fun.spermaticusis possible to “shift” the deep inguinal ring medially, crossing the
lower epigastricvessels andholdingthe testis underthem;
- it is possible to transplantthe testicle to the lower epigastric vessels using microsurgical
techniques.At the same time preservem.cremaster;
- orchiopexyat the bottomof the scrotumby Petrivalsky(in the pocket formedbetween the skin of
the scrotumandtunicadartos);
- with considerabletension of the spermaticcord, the testicle is placed higherand in 6 – 12 months
performphaseII – orchiopexyin the scrotum;
- in abdominalcryptorchidismand a significant shorteningof the spermaticcord laparoscopically
after mobilization of the testicle it is possible to fix it in the abdomen in the projectionof the
opposite of the superficialinguinalring;after6-8 weeks, performa second stage of the operation–
orchiopexy.
In the postoperativeperiod:
- aspirin,quercetin,Vit.C (to strengthengematotesticularbarrier);
- Vit.E, riboxin,(for the recoveryof vascularizationof the testis);
- courseof treatment- 21 days (Vit.E, aspirinandriboxin)every 3 monthsduringthe year;
- hyperbaricoxygen therapy(minimumof 5 sessions);
- in case of testicularhypoplasia,it is advisableto use injectionsof chorionicgonadotropin(only on
the recommendationof an endocrinologist).
Complications:
- infertility;
- malignancy with the emergence of seminoma (through this men who had cryptorchidismin
childhood,shouldbe on the dispensaryaccountat the urologist);
- strangulatedinguinalhernia,torsionof the testicle.

Hydrocele is the accumulationof serous fluid in the vaginal tunic of the testicle through the
unobliteratedvaginal process (congenital hydrocele), or its recanalization. It is considered to be
physiological up to 6 months of age. The acquired form occurs in violation of the lymphatic
drainage of the testicle due to its trauma,inflammationand/or as a postoperativecomplication
(usuallyfoundin adults).
Forms:
- communicatinghydroceleof the shells of the testicle andthe spermaticcord;
- communicatinghydroceleof the shells of the spermaticcord;
- isolatedhydrocele(cyst) of the testicularmembrane;
- isolatedcyst of the membranesof the spermaticcord.
Clinic:
- gradualincrease in the correspondinghalf of the scrotum,mainly in the vertical position of the
body (until the evening) and decrease in the horizontalposition (in the morning after sleep may
disappear);
- palpatorydetectionof a roundeddense elastic non-painfulformationin the scrotumnot associated
with the skin, the densityof which increasesin the evening;
- the testicle is not palpableseparately;
- the skin of the enlarged half of the scrotum is unchanged,sometimes it can have a somewhat
grayishcolor due to the transilluminoationof the liquidthroughit, its folds aresmoothed;
- rarely,mainly in infants,acute hydrocelemay occur, characterizedby a significantincreasein the
correspondinghalf of the scrotum and a sharp concern of the child, crying, which appears or
increaseson palpationof the scrotum(emergencycare – puncture;it is necessaryto differentiateit
with a strangulatedinguinal-scrotalhernia!).
Diagnostics:
- moreoften clinical;
- transillumination;
- ultrasoundof the scrotumandinguinalareas.
Treatment:
- physiological hydrocele does not need treatment;it is recommendedto swaddle the child so that
the bottomof the scrotumis directedanteriorly;
- if the physiological hydroceledoes not disappear,but tends to decreasein the process of dynamic
observation,the operationis usuallyperformedat the age of about1.5 years;
- indicated at an earlier age in the absence of a tendency to decrease or its rapid progressionin
infants;
- surgery:
- laparoscopic(by PIRSmethod);
- Ross operation(separationof the vaginalprocessfromthe elementsof the spermaticcord,ligation
at the base and removal of the vaginal process with the fenestrationof the vaginal shell of the
testicle).

Inguinal hernia in children occurs when any organ of the abdominal cavity (most often the
intestine,sometimes a greateromentum)penetratesthroughthe base of the vaginal process into the
inguinalcanal;hernialsac in this case often ends blindly,butsometimeson the backwall of the bag
testis can be located (such a herniais called congenital or testicular).Rarely inguinal herniacan
occur in girls, then often hernialcontents is the appendageof the uterus.Thus, inguinalherniasin
childrenarealmostexclusively oblique(indirect).
Clinic:
- the sudden appearanceof a rounded or oval protrusionin the correspondinginguinal region
mainly on tension, crying, coughing of the child, which is usually freely reducted (suddenly
disappears,often spontaneously)into the abdominalcavity;
- formationis as usual soft-elastic, painless, a distinctive rumblingis often felt with the reduction;
the skin over it is unchanged;
- when inguinal-scrotalherniacontentsdescendsinto the scrotum;
- when herniaincarceration,the child becomes extremely restless, the protrusionhardens,doesn't
reduce, becomes be painful, the skin over it after some time turnsred; may be signs of intestinal
obstruction(abdominaldistension, vomiting, absence of feces and gases) – this condition requires
urgentsurgicalintervention.
Diagnosis is the same as in hydrocele.
Differentialdiagnosis:
- hydrocele(may be accompaniedby hernia);
- inguinalcryptorchidism(may be accompaniedby hernia);
- inguinal(femoral)lymphadenitisor lymphadenopathy;
- dermoidcyst, Nuck cyst.
Treatment:
- due to the tendency to pinching the optimal age for the operationdoes not exist, it is better to
performa plannedinterventionaftera full examinationandcorrectionof all comorbidities;
- surgical:
- laparoscopic(by PIRSmethod);
- herniotomythrougha transverseapproachin the correspondinginguinal region, usually without
opening the inguinal canal and hernioplasty;if necessary (when a significant stretching of the
anterior wall of the inguinal canal and/or of the superficial inguinal ring) – plastic by Ru-
Krasnobayev;in olderchildren– moreoften plasticby Martynov.
Duhamelsurgery:removalof the hernialsac withoutcanalplastyis performed.
Ru-Krasnobayevsurgery:after removing the hernial sac the plasty of the inguinal canal without
openingof the frontwall is performed.The firstsutureis imposedon the legs of superficialinguinal
ringandinnercornerof the inguinalligament,resultingdublicatorimpose nodalsutures.
Martynov'soperation:dissect the anteriorwall of the inguinal canal, remove the hernialsac. The
plastic of the anteriorwall is performedby suturingthe inner sheet of aponeurosisof the external
oblique muscle to the inguinalligament,and then the outersheet of aponeurosisto the internalone
by the type of duplicature.This techniqueis used mainlyin olderchildren.

Independent Study
Hernia of the white line of the abdomen is protrusionthroughthe slit-like defects of the white line of the
abdomen.In this firstpreperitonealfat tissue (preperitoneallipoma)bulges, andlatera hernialcontentscan go out
.
Classification by O. M. Krymov:- supraumbilical;-paraumbilical,- umbilical.The last practicallydo not appear.
Clinic: leakageis often asymptomatic,protrusionalong the medianline (l.alba)is moreoften foundaccidentallyat
the age of 5-7 years.Sometimestheremay be painon the strangulationof "lipoma".
Treatment– only surgical(herniotomywith plastichernia,often by Sapezhko).

Pathology of the vitelline duct (omphalomesenteric duct anomalies) and urinary duct (urachal remnants).
In the early embryonicperiod,the vitelline duct connects the yellow body with the lumen of the midgutand after
the formationof the placentanormallyacquiresa complete reversedevelopmentand disappeares.The bladderis
connected to the embryonic membrane(alantois) by the urinaryduct (urachus) in the navel area, which is
normallyobliteratedbeforebirthto formthe medianplica of the bladder.
The five omphalomesenteric duct defects, in decreasingorderof incidence,are:
- Meckel’sdiverticulum: the clinic is manifested by complications:intestinal bleeding, diverticulitis,intestinal
intussusception,intestinalobstruction(strangulationof the diverticulumin the hernia– Littre'shernia);surgical
treatment– removalof the diverticulum;
- incomplete umbilical fistula (the umbilical end isn't obliterated – umbilical polyp with blind pouch):
characterizedby appearanceof liquiddischargefrombelly button,at the bottomof the navel can be formedpolyp,
possible infection with the appearanceof purulentdischargeand redness of skin aroundumbilicus;diagnosis –
sensing (probing)of navel, (chromo)fistulography);treatment– conservative(cauterization (coagulation)of the
mucous membraneof the fistula (96% solution of alcohol, 3% solution of KMnO4, 10% solution of AgNO3 , 10%
solution of I2)), or surgical (excision of the fistula with the audit for the presence of a cord, reaching to the
intestine);
- vitelline duct cyst: sometimes palpated in the abdomen,wheninfection – possible pain and redness on the
anterior abdominal wall; diagnosis – ultrasound, CT; complications – rupture with peritonitis, intestinal
obstruction;surgicaltreatment– removal;
- complete umbilical fistula (patent omphalomesentericduct): detected most often over the age of 1 month, is
characterizedby the release of chymus (foul-smelling mass), gas or feces through the navel, diagnosed by
fistulography(chromophotography);possible complications– protrusion(evagination)of the wall of the ileum (is
presented by bright pink "rosette"of the mucous membraneat the bottom of the navel, exicosis, intestinal
obstruction;operationin 3-6 months.in the absence of complicationsandis laparotomy(laparoscopy)with fistula
excision, when complications– urgently);
- persistentfibrouscord: sa usual is asymptomatic,but may cause intestinalobstructiondue to intestinaltwisting
aroundit.
Urachal remnants are:
- complete uracal fistula (patenturachus):manifestedby excretion of urine from the navel; diagnosis - probing,
(chromo)fistulography;complications - infection of the urinary tract; surgical treatment in 3-6 months -
extraperitonealremovalof the fistulawith the skin of the navel;
- incompleteurachalfistula (urachalsinus):see above - incompleteumbilicalfistula;
- diverticulumof the bladder (urachaldiverticulum):characterizedby double-motilityurination,and the second
portionof urineis usually cloudy; diagnosis - cystography/scopy,ultrasound;surgicaltreatment- removalof the
diverticulum);
- urachal cyst: motionless formationis palpatedbelow the navel in the midline, diagnosis - ultrasound;surgical
treatment;
- urachalchorda: the entiretractpersistsas a cord.
Persistent umbilical-mesenteric artery can manifestby strangulatedbowel obstruction; emergencyoperationis
indicated.

Congenital aplasia of the muscles of the anterior abdominal wall (plum belly syndrome) is a rarecongenital
pathologyconsisting in underdevelopmentof the abdominalwall muscles of variousdegrees:most often thereare
no transverse and oblique muscles, since embryogenesis disorders often occur in the late stages of fetal
development,moreoften in boys.
Theories of development: a result of postponed polio in mother, compression of anteriorabdominal wall by
expandedbladder,interruptionof originof nervetrunksin embrio.
Embryogenesis: the abdominal wall is formed at the end of the 1st-beginning of the 2nd week of gestation,
straightmuscles are formedfirst. Up to 7-10 weeks, the muscles completely close the abdominalcavity, leaving
only the umbilicalringopen;on the 3rdmonth,the lateralmuscles aredifferentiated.
Parker's syndrome is too typical for this defect (triad): bilateral cryptorchidism,aplasia of the muscles,
dysfunctionof organsof the urinarysystem (megacystis, megaureter,hydronephrosisup to 90% of cases). In 20-
28% of cases thereis a combinationwith malformationsof the digestive channel,in 41% - with malformationsof
the lower extremities,in 55% - with heartdefects, in 50% - with urachalremnants;90% of boys have bilateral
cryptorchism.
Clinic: there is a relaxationof the abdominalwall; due to the high standingof diaphragmand wide rib angle –
shortness of breath, congestive wheezing; as a rule – stable constipation, coprostasis, possibly – intestinal
obstruction.
Diagnostics: an overview andinvestigationof the urinarysystem.
Treatment:immediatelyafterbirth– correctionof urinarysystem defects (if they arepresent).
Preoperativepreparation:
- massageof the abdominalwall, firstpassive, thenactive, up to 2-3 times a day;
- exercise to increaseperistalsisandstrengthenthe muscles;
- bandage,when the child begins to walk.
Surgicaltreatment– at 2-3 yearsof age, options:
- corrugationwith removalof excess skin;
- the formationof duplicationfromtissues of the anteriorabdominalwall by Mirabelle;
- the formationof duplicationfromall the layersof the anteriorwall by Yu.F.Isakov.
In the postoperativeperiod – prevention and treatmentof respiratoryfailure, paresis of the intestines, belly
massage,bandage.