ABDOMINAL WALL DEFECT

Abdominal wall defect has two main types:

Omphalocele. An omphalocele is an opening in the center of the abdominal wall where the umbilical cord meets the abdomen. Organs (usually the intestines, stomach, and liver) protrude through the opening into the umbilical cord, covered only by a thin membrane. An omphalocele is frequently accompanied by other birth defects and genetic syndromes. Your doctor may recommend genetic testing if he or she discovers an omphalocele prenatally. A genetic testing can offer better information about your baby’s condition.

Gastroschisis. Gastroschisis is a defect in the abdominal wall, usually to the right of the umbilical cord, through which the large and small intestines protrude (although other organs may sometimes bulge out). Unlike an omphalocele, there is no membrane covering the exposed organs in gastroschisis.  This also is not generally linked to any genetic syndrome.

Abdominal wall defect symptoms may include:

• Abdominal organs visibly protrude out through the skin, probably covered by a thin membrane
• Digestive problems due to poor circulation and irritation of the digestive organs as an effect of their location outside the body
• A bubbled or bulging appearance around the baby’s umbilical cord

Whichever type of abdominal wall defect, there is a risk of infection and injury because the organs are not protected inside the body as they should be. Also, there is a risk that parts of the digestive system could be twisted or pinched, which compromises blood supply. A loss of blood flow to the digestive system can cause severe problems.

DIAGNOSIS

Abdominal wall defects are usually recognized and diagnosed through prenatal ultrasound during the second trimester of pregnancy. A multidisciplinary group of specialists in maternal-fetal medicine, pediatric surgery, neonatology and other specialties will create a care plan for your baby’s delivery, as well as treatment in the neonatal intensive care unit (NICU).

During a physical examination at birth, abdominal wall defects are visible. Your baby’s doctor may evaluate the severity of the condition through X-ray imaging, performed in a moment after birth.

Both types of abdominal wall defects are commonly diagnosed before birth with routine prenatal ultrasonography. If not, the defects are very recognizable as soon as the infant is delivered.

TREATMENT

If a baby has an abdominal wall defect, the rest of the abdomen may be underdeveloped and small. In numerous cases, there is insufficient room in the abdomen to instantly move the organs back inside the body and correct the defect. The organs must stay outside the body for a small number of days after birth to give the abdomen time to grow.

Sterile protective sheeting is placed over the organs, and a device known as a silo is put in place to provide an extra protective layer when immediate surgery is not an option. A silo protects and houses the protruded organs until the abdomen grows enough to contain the digestive organs. Your baby, while waiting for surgery, may also receive breathing help from a machine called a mechanical ventilator.

After a few days or weeks after birth, when it is safe for your baby to have the abdominal wall defect be fixed, digestive organs are gently put back into the abdomen.

Dietitians who specialize in treating babies with abdominal wall defects can work with you to search for feeding options that lessen any irritation and provide adequate nourishment.