Dr Ruankha Bilommi

Spesialis Bedah Anak

Abdominal Wall Defects

To identify different congenital anomalies that
are present at birth.
GASTROSCHISIS
 Gastroschisis

No membrane covering
Abdominal wall defect typically 2-4cm diameter
Lateral to the right side of the umbilical cord
Usually contains midgut and stomach
Thickened, atretic, and possibly ischemic bowel
Associated with malrotation
 Treatment
NGT to low intermittent suction
Use of bowel bags
STERIL PLASTIC WRAP ; urine bag. blood ba
g. Silo
Conservation of and fluid loss
es
Antibiotics
Careful positioning to avoid kinking of mesenteri
c vessels
 Surgical Management

Operative repair within 2-4 hours of birth.

GOLDEN PERIOD IS BEFORE 8 HOURS
AFTER BIRTH.
INCREASED MORTALITY
Abdominal wall defect;
Gastroschizis
Abdominal wall defect;
OMPHALOCELE
 Omphalocele

Membrane sac arising from the umbilical cord cov

ers intestines
Outer membrane layer consists of amnion and inn
er lining of peritoneum
Size ranging from small->giant defects containing l
iver, small and large bowel, stomach, spleen, ovari
es, and testes
Associated with foreshortened bowel and malrota
tion
Small abdominal cavity and pulmonary hypoplasia
 Omphalocele
Probable genetic predisposition
Associated syndromes and anomalies (45-55%):
- gastrointestinal
- cardiac
- trisomy 13, 18, 21
- OEIS complex (omphalocele, bladder extrophy,
imperforate anus, spinal defects
- Beckwith-Wiedemann
- pentalogy of Cantrell
- cleft palate
- pulmonary hypoplasia
 SURGICAL TREATMENT ; Primary
closure
Treatment options in infants with
omphalocele depend on the size of the defect,
gestational age, and the presence of
associated anomalies.

In infants with small defects, primary closure e

consisting of excision or inversion of the sac,
with closure of the fascia and skin e may be
easily accomplished.
CONSERVATIVE TREATMENT; WITH
ESCAROTIC AGENT
UMBILICAL HERNIA
Benjolan di umbilicus
Bladder extrophy-epispadia complex
www.kiddsurgery.net
drrubedahanak.org