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ABDOMINAL WALL DEFECTS

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ABDOMINAL WALL DEFECTS Dr. Catherine B. Canete UMBILICAL HERNIA Defect in linea alba, subcutaneous tissue and skin covering the protruding bowel Frequent in premature ... – PowerPoint PPT presentation

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Title: ABDOMINAL WALL DEFECTS


1
ABDOMINAL WALL DEFECTS
  • Dr. Catherine B. Canete

2
OMPHALOCOELE
  • Anterior abdominal wall defect at the base of the
    umbilical cord with herniation of the umbilical
    contents

3
Incidence
  • Small omphalocoele 15000
  • Large omphalocoele 110000
  • Male to female ratio 11
  • Pacific Islanders have low risk for omphalocoele

4
Pathophysiology
  • Failure of the midgut to return to abdomen by the
    10th week of gestation

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Clinical Findings
  • Covered clinical defect of the umbilical ring
  • Defect may vary from 2-10 cm
  • Sac is composed of amnion, Whartons jelly and
    peritoneum

8
  • 50 have accompanying liver, spleen, testes/ovary
  • gt50 have associated defects
  • Location
  • Epigastric
  • Central
  • Hypogastric
  • Cord attachment is on the sac

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GASTROSCHISIS
  • Defect of the anterior abdominal wall just
    lateral to the umbilicus

11
Incidence
  • 120,000-30,000
  • Sex ratio 11
  • 10-15 have associated anomalies
  • 40 are premature/SGA

12
Pathophysiology
  • Abnormal involution of right umbilical vein
  • Rupture of a small omphalocoele
  • Failure of migration and fusion of the lateral
    folds of the embryonic disc on the 3rd-4th week
    of gestation

13
  • Lateral folds
  • Form
  • Lateral abdominal wall
  • Future umbilical ring

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Clinical Findings
  • Defect to the right of an intact umbilical cord
    allowing extrusion of abdominal content
  • Opening ? 5 cm
  • No covering sac

16
  • Bowels often thickened, matted and edematous
  • 10-15 with intestinal atresia

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MANAGEMENT
  • ABC
  • Heat Management
  • Sterile wrap or sterile bowel bag
  • Radiant warmer
  • Fluid Management
  • IV bolus 20 ml/kg LR/NS
  • D10¼NS 2-3 maintenance rate

19
  • Nutrition
  • NPO and TPN
  • Gastric Distention
  • OG/NG tube
  • Infection Control
  • Ampicillin and Gentamicin
  • Associated Defects

20
  • Conservative treatment
  • Reduction by squeezing the sac
  • Painting sac with escharotic agent
  • 0.25 Silver nitrate
  • 0.25 Merbromin (Mercurochrome)

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  • Surgical Management
  • Skin Flaps
  • Primary Closure
  • Staged Closure
  • Staged repair using silo pouch

23
Skin Flaps
24
Primary Closure
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Staged Closure
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34
UMBILICAL HERNIA
  • Defect in linea alba, subcutaneous tissue and
    skin covering the protruding bowel
  • Frequent in premature infants

35
PRUNE BELLY SYNDROME
  • Thin, flaccid abdominal wall
  • Dilation of bladder, ureter and renal collecting
    system
  • 130,000-50,000
  • 95 are male

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BLADDER EXTROPHY
  • Defective enfolding of caudal folds
  • 3.3 in 100,000 births
  • Associated with prolapsed vagina or rectum,
    epispadias, bifid clitoris or penis

38
PENTALOGY OF CANTRELL
  • Omphalocoele
  • Anterior diaphragmatic hernia
  • Sternal cleft
  • Ectopia Cordis
  • Intracardiac defect

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40
BECKWITH-WIEDEMANN SYNDROME
  • Macrosomia
  • Macroglossia
  • Organomegaly
  • Abdominal wall defects
  • Embryonal tumors

41

Omphalocoele Gastroschisis
42

Omphalocoele Gastroschisis
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