Abdominal Wall Defects
Also known as: Omphalocele; Omphalocoele; Exomphalos; Gastroschisis
Exomphalos, otherwise known as omphalocoele or omphalocele, is a condition where the abdomen fails to close around the base of the umbilical cord during the early development of the baby. As a result the abdominal organs poke out into the base of the umbilical cord.
Gastroschisis is a condition where there is a defect in the abdominal wall to one side of the umbilical cord (usually the right side). Usually some of the bowel escapes through this hole and develops outside of the baby’s abdomen.
The umbilical cord is the connecting cord from the developing baby to the mother, from which the baby gets oxygen and nutrients.
Medical text written May 1994 by Mr NE Dudley, Consultant Surgeon, John Radcliffe Hospital, Oxford, UK. Last updated December 2012 by Mr J Curry, Consultant Paediatric Surgeon, Great Ormond Street Hospital, London, UK.
The size of the exomphalos depends on the number of organs exposed. This is usually the bowel but may include the liver and other organs. The sac containing the exposed organs is usually covered in a protective membrane. Sometimes exomphalos occurs in conjunction with other problems such as chromosomal (gene) or heart defects.
In gastroschisis some of the bowel has escaped through a hole in the abdominal wall and develops outside of the baby’s abdomen. The bowel floats around in the amniotic fluid – this is a liquid that surrounds the unborn baby (fetus) – in the mother’s womb for most of the pregnancy and sometimes the fluid irritates the bowel and makes it inflamed and thick, so that it does not work properly. Sometimes the bowel becomes twisted as it floats in the fluid and the blood supply is restricted. When the baby is born, the bowel is exposed to the air which sometimes causes further inflammation to occur.
Exomphalos can, in some circumstances, be associated with genetic abnormalities. It occurs across all maternal (mothers) ages.
Gastroschisis is associated with young maternal age, with mothers under 20 years being twelve times more likely to have infants with gastroschisis. It is usually not associated with other abnormalities outside of the intestine.
Most babies with abdominal wall defects will be identified during pregnancy by fetal ultrasound.
The parts exposed out of the baby’s abdomen are usually wrapped in surgical cling film, which helps prevent infection. Once the baby is stable, surgery can be performed. If there is only a small amount of bowel outside the abdomen, it will be returned to the baby’s abdomen and the wound closed. This is called a primary repair.
Sometimes if the gastroschisis/exomphalos is large or if the abdominal cavity is small, a surgeon will construct a pouch in which the gastroschisis/exomphalos is placed. The pouch is then suspended from the ceiling of the incubator and gravity along with a reduction of the size of the pouch will help the gastroschisis/exomphalos to slip back inside the abdomen. This can usually be done in a week for gastroschisis, but may take considerably longer for exomphalos.
Some genetic syndromes are associated with exomphalos (eg Beckwith-Wiedemann syndrome). Gastroschisis is virtually always an isolated abnormality with no pattern of inheritance.
Diagnosis can be made by ultrasound scan during pregnancy.
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