Omphalocele

Anterior abdominal wall defects and biliary obstruction

Three infants with anterior abdominal wall defects (gastroschisis and exomphalos) who presented with obstructive jaundice secondary to biliary obstruction, are described. All three infants had abnormal biliary systems, with mechanical distortion of the biliary tree. Biliary obstruction secondary to structural biliary anomalies should be considered in patients with abdominal wall defects and cholestasis, as prolonged unrelieved biliary obstruction may lead to biliary cirrhosis and portal hypertension.

Omphalocele associated with coronary sinus atrial septal defect: report of two cases

Two children with omphalocele were found to have coronary sinus atrial septal defect as part of their congenital heart disease complex. This unusual atrial communication may elude preoperative detection unless specifically sought. Its occurrence in conjunction with omphalocele may represent more than a chance association.

Medulloblastoma in infancy associated with omphalocele, malrotation of the intestine, and extrophy of the bladder

A successfully treated case of infantile medulloblastoma is presented that was associated with omphalocele, malrotation of the intestine, and extrophy of the bladder. A 5-month-old boy was admitted due to disturbance of consciousness and was diagnosed by computed tomography as having a medulloblastoma. Ventricular drainage, subduralperitoneal shunt, and removal of the tumor were performed, and postoperatively radiation therapy was administrated with 4,000 rad to the whole brain. He was discharged in good condition and no evidence of recurrence was observed at the 14th post-operative month. Medulloblastomas associated with congenital anomaly of the abdomen have been only rarely reported. The authors postulate that between the second and third month of gestation an intrinsic or extrinsic factor may have caused the development of the medulloblastoma, as well as anomalies of the abdomen such as omphalocele, malrotation of the intestine, and extrophy of the bladder.

Omphalocele and gastroschisis

This brief article outlines our philosophy and management of omphalocele and gastroschisis based on personal experience with more than 200 patients.

Possible mesodermal origin for axial dysraphic disorders

We report four patients who provide clinical evidence supporting the hypothesis that axial dysraphic states may result from a primary disturbance in the chordoaxial mesoderm. One infant had complete craniorachischisis, an omphalocele, and ambiguous genitalia. A second infant had anencephaly and an omphalocele. The third had iniencephaly. The fourth had cervical vertebral fusion defects, an occipital menigocele, and a laterality malformation sequence. Alteration in the development of structures derived from the chordoaxial mesoderm could explain all of the structure defects observed in the four patients. This hypothesis accounts for the nature of the defects seen in association with dysraphic disorders and for the genetic relationship observed between neural tube defects and vertebral anomalies.

Omphalocele: experience in the African tropics

Omphalocele, the congenital anomaly of the anterior abdominal wall in the newborn, is a serious condition with a grave prognosis. Sac rupture, occurring in 25% of cases in Ibadan is associated with a high mortality. Although its embryogenesis is now better understood, its underlying aetiology remains obscure. Prematurity and low birth weight have no causal relationship to the condition, but a preponderance among the lower socio-economic groups in Ibadan is observed. Thirty-three cases seen over a 5-year period at the University College Hospital, Ibadan, Nigeria, constitute an unusually high incidence, suggesting that the condition may be aetiologically related to umbilical hernia which is known to be commoner in African than in Caucasian infants. Overall treatment results remain unsatisfactory for all types and mortality is still high. In those centres, particularly in the developing countries with scarce resources, conservative management should be the primary treatment modality for all intact sacs but staged procedures utilizing prosthetic materials should be reserved for the large ruptured sac.

The effect of C.P.A.P. upon pulmonary reserve and cardiac output under increased abdominal pressure

The cardiopulmonary effects of CPAP under conditions of increased intra-abdominal pressure were studied using the rabbit as an experimental model. Central venous pressure and cardiac output were reduced when the intra-abdominal pressure was increased. Addition of CPAP caused a further reduction in C.V.P. and C.O. Despite these reductions CPAP significantly improved arterial PaO2 without significant effects on pH and PaCO2. The use of CPAP in conditions associated with pulmonary dysfunction secondary to increased intraabdominal pressure may be a definite therapeutic modality.

Exomphalos and gastroschisis: a 10-year review

Ninety-six cases of exomphalos or gastroschisis managed at The children's Hospital, Sheffield, during the period 1964-74 are analysed. There were 306 cases with minor lesions, 30 with major lesions, 27 with a ruptured exomphalos and only 3 with gastroschisis. The overall mortality rate was 46-9 percent. Survival could be closely correlated with the birth weight, the nature of the primary lesion, the presence or absence of liver within the sac and the presence and severity of associated congenital anomalies. A "scoring system" based on these criteria is proposed to predict the prognosis of an infant with an exomphalos.

Omphalocele

From a historical curiosity at the turn of the century, today omphalocele and gastroschisis can be corrected with good results, thanks to innovative techniques and better understanding of the newborn. Associated anomalies consist mainly of malrotation, Meckel's diverticulum, intestinal atresia, congenital heart defects, and genitourinary abnormalities. Nonoperative management in certain centers has been sucessful for the very large omphaloceles with an intact sac; however, a secondary procedure is necessary. In the past 10 years, the use of Silastic sheeting and total parenteral nutrition has allowed early repair of even the most severe cases, with excellent end results and low mortality.