Abdominal Wall Defects & Hernias in
Children
•
MM
By:
Maj Asrar Ahmad
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Anatomy
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Embryology
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Types


Omphalocele
Gastroschisis
Copyright, 1996 © Dale Carnegie & Associates, Inc.
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Omphalocele



Covered by membrane
Umbilical cord inserts into
the sac
Typically contain bowel
and/or liver, stomach and
spleen
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Types of Omphalocele

Central - failure of fusion of lateral
folds

Epigastric - failure of fusion of
lateral and cephalic folds

Hypogastric - failure of fusion of
caudal and cephalic folds
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Omphalocele
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Comparison
GASTROSCHISIS
OMPHALOCELE


1:4,000 to 10,000
Covering sac present
Cord onto sac

Herniated bowel normal





Anomalies 45 to 55 %
Survival 20%-70%




1:20,000 to 30,000
Covering sac absent
Cord onto abdominal
wall
Bowel edematous,
matted
Anomalies 10 to 15%
Survival 70-90%
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Omphalocele
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Associated GI Anomalies





Midgut volvulus
Meckel’s diverticulum
Intestinal atresia
Intestinal duplication
Malrotation
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6 month old infant
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Beckwith-Wiedemann Syndrome





Hepatomegaly, hemihypertrophy
Adrenal carcinoma, Wilm’s tumor
Gonadoblastoma, hepatoblastoma,
large ovaries, hyperplastic uterus
and bladder, bicornuate uterus,
hypospadias
Immunodeficiency
Cardiac hamartoma, focal
cardiomyopathy
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Gastroschisis



Small abdominal wall
defect, lateral to the
umbilicus
Umbilical cord attached to
abdominal wall to the left
of defect
No limiting sac, viscera
often limited to small
intestine and ascending
colon
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Gastroschisis



Ischemic compromise due to
compression of mesenteric blood
vessels when defect is small
Serositis and serosal peel result
from amniotic fluid exposure
Ischemic changes and atresia are
late events related to mesenteric
constriction
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Hernia of the Umbilical Cord
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Umbilical Hernia


Defect in linea alba,
subcutaneous tissue
and skin covering
the protruding bowel
Frequent in
premature infants
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Management


ABC (5-Hs)
Heat Management



Sterile wrap or sterile bowel bag
Radiant warmer
Fluid Management


IV bolus 20 ml/kg LR/NS
D10¼NS 2-3 maintenance rate
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Management

Nutrition


Gastric Distention


OG/NG tube
Infection Control


NPO and TPN
Ampicillin and Gentamicin
Associated Defects
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Management

Conservative treatment


Reduction by squeezing the sac
Painting sac with escharotic agent
 0.25%
Silver nitrate
 0.25% Mercurochrome lotion
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Management

Surgical Management



Skin Flaps
Primary Closure
Staged Closure
 Staged
repair using silo
pouch
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Surgery
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Skin Flaps
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Hernias In Children

Definition

Anatomy

Common Types

Management
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Anatomy
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Types

Inguinal

Femoral

Umbilical
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Inguinal Hernia
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Hydrocele

Inguinal

Femoral

Umbilical
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Types

Inguinal

Femoral

Umbilical
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Obstructed Hernia
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Strangulated Hernia
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Management
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Management
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Umbilical Hernia
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Umbilical Hernia
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