Abdominal Wall Defects

Gastroschisis is a full-thickness abdominal wall defect, typically located to the right of the umbilicus, around 4 cm in size, through which peritoneal contents—most often intestines—protrude without any membranous covering. It occurs in otherwise normal babies following an intrauterine developmental event, and is associated with young maternal age, prematurity, and low birth weight. Most gastroschisis patients lack other associated anomalies or chromosomal abnormalities. Two types of intestinal atresia can complicate gastroschisis: early-onset atresia with dilated but thin-walled bowel, and late atresia from a constricting defect causing ischemia. Gastroschisis carries higher risk of adhesive bowel obstruction compared to omphalocele.

Management of necrotizing enterocolitis involves surgical intervention decisions and supportive care strategies. For surgical management, laparotomy and peritoneal drainage show different outcomes: laparotomy resulted in improved long-term neurodevelopmental outcomes despite similar overall survival rates. Silo placement with delayed closure offers multiple advantages including decreased incidence of necrotizing enterocolitis, earlier extubation, decreased airway pressures, more rapid bowel function recovery, and shorter hospital stays. Severe diffuse necrotizing enterocolitis causing abdominal compartment syndrome may be managed using a silo. Intestinal rehabilitation programs provide multidisciplinary coordinated care for children developing short bowel syndrome as a consequence of necrotizing enterocolitis.

A hernia is a protrusion through a defect in the abdominal wall. In the context of abdominal wall defects, hernias occur when tissue or bowel extends through an opening. Umbilical hernias, the most common type discussed, can present with varying sizes and clinical significance. True incarcerated umbilical hernias present with bowel obstruction symptoms; however, if a child is eating well, it is not an emergent incarcerated hernia. Most umbilical hernias close spontaneously during early childhood, though larger defects are less likely to close without intervention.

Omphalocele is a rare birth defect that is serious and can be life-threatening for babies before and after birth. It occurs right through the middle of the umbilicus and has a membranous cover. The cause is unknown. Omphaloceles can be classified by size: giant omphalocele is typically defined as five centimeters or greater or when liver is in the sac. Omphalocele can be a feature of many genetic syndromes, with trisomy 13, 18, and 21 being major risk factors, occurring in 35–90% of patients. Patients with omphalocele have non-rotation or malrotation of the bowel.