Abdominal wall defects

SummaryHerniation of viscera through defects of the abdominal wall can be categorised into gastroschisis, omphalocele, and the rarer bladder or cloacal exstrophy. Many of the principles of diagnosis and management are similar for these conditions. Gastroschisis is a small defect positioned to the right of the umbilicus. The herniated viscera are not covered by a membrane. Gastroschisis is usually an isolated abnormality, but these infants frequently have significant intestinal dysfunction. Omphalocele is a defect of the umbilical cord itself and can be small to very large. The herniated organs are covered by a sac. Associated abnormalities are frequent and significantly affect outcome. Most abdominal wall defects are diagnosed prenatally. Location and route of delivery can then be chosen to facilitate postnatal management. Initial treatment consists of coverage of the viscera and fluid resuscitation. Several options are then available for definite surgical management, depending on the size of the defect, the condition of the underlying viscera, and the status of the baby. Most infants have good long-term prognosis.