Defects of the Abdominal Wall

In humans, internal organs are housed in a cavity, such as the chest cavity or the abdominal cavity. A weakness in a cavity wall can cause a hernia, characterized by the protrusion of internal organs or other tissues outside the walls that normally contain them.
Abdominal wall defects can cause herniation of abdominal organs, so that they protrude outside of the abdominal cavity. Surgical treatment is often necessary for these congenital defects of the gastrointestinal system in order to contain the abdominal organs in the cavity. These malformations can affect several organs of the gastrointestinal tract.

Types of Abdominal Wall Defects

Congenital weaknesses in the abdominal wall usually lead to one of two conditions:
  • Omphalocele: An omphalocele is a herniation of the intestines or other abdominal organs (such as the liver) outside of the body into the umbilical cord, and out through the navel. The organs are covered by a thin layer of tissue. Babies with an omphalocele are more likely to suffer from other birth defects as well.
  • Gastroschisis: Gastroschisis is another form of hernia that affects the abdominal wall. The intestines protrude outside the body through a defect to the side of the umbilical cord. However, in people with gastroschisis (unlike in an omphalocele), the internal organs are not covered by a membrane.

Treatment for Defects of the Abdominal Wall

Treatment for congenital defects of the abdominal wall is almost always surgery. It involves replacing the abdominal organs inside the abdominal cavity, and repairing the weakness, hole or defect in the abdominal wall. Many different options exist for surgical treatment, and decisions are made on a case-by-case basis.
In cases of gastroschisis, surgery is often performed soon after birth, because there is no sac to protect and cover the intestines. In some cases, if the abdominal cavity is too small to replace the protruding intestine all at once, the intestines are encased in a mesh sac and hung above the child, so they can return gradually into the abdominal cavity by force of gravity.
Some omphaloceles are treated immediately, particularly if the sac containing the internal organs is fragile, or if it ruptures. In other cases, when a baby is in stable health, the omphalocele may be treated with a topical cream to toughen the sac, and surgery may be postponed until the child's abdominal cavity has grown to better accommodate the protruding organs. In this case, surgery is usually performed at 6 to 12 months of age.

Preparing for a Baby with an Abdominal Wall Defect

Fortunately, with current ultrasound technology, many cases of omphaloceles and gastroschisis can be detected before birth, especially those that are more severe and clearly seen in an ultrasound.
This means that parents and surgeons can prepare adequately for the birth, and determine several possible courses of treatment to be considered depending on the specific details of the baby's condition after birth.

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