OmphaloceleOmphalocele:

An abdominal defect in which the:

intestines, liver, and other organs remain outside the abdomen in a sac.

Omphaloceles are a defect in the development of the muscles of the abdominal wall.

Surgical Intervention is required to put the abdominal organs back into the abdominal cavity.

 


Differences of Gastoschisis and Omphalocele


Gastroschisis is when the abdominal organs freely protrude through the abdominal wall in-vitro.  There is no protective sac around the organs.

Omphalocele is when the fetus is more developed. The fetus has gone through development stages to where the abdominal area has formed the sac that contains the abdominal organs, though it does not develop completely. Leaving the sac to protrude through the abdominal cavity.


How will I know if my Baby is at Risk?


The diagnosis of omphalocele is usually made by ultrasound, in many cases following an elevated second trimester maternal serum alpha-fetoprotein test. Omphalocele is seen in approximately 1 in 10,000 births and occurs when the majority of the liver protrudes into the umbilical cord. Herniation of the fetal liver is frequently associated with a small abdominal size and can cause underdevelopment of the lungs. These are two factors that can complicate the post-natal (after delivery) course.


Treatment Options


The size of the herniation determines the mode of delivery as well as the postnatal treatment of omphalocele, while the degree of liver involvement determines the level and type of omphalocele treatment. If the omphalocele is small and does not involve the liver, a vaginal delivery might be possible.

After birth, the exposed organs are returned to the abdominal cavity and the herniation is closed via surgery. During and after surgery, the baby might be on a ventilator for several days to aid breathing. A larger omphalocele usually requires a Cesarean delivery to avoid membrane rupture and liver trauma. The exposed organs are covered with a protective wrap, and the organs gradually return to the abdominal cavity with the aid of gravity. In some cases, a staged surgical repair might be required. Once the organs are returned to the abdomen, the omphalocele is closed surgically.

During this time, the baby will also be on a ventilator. Surgery to close the abdominal wall defect may be postponed some six to 12 months to allow the abdominal cavity to enlarge as the baby grows. Possible complications during this time include respiratory compromise, infection and feeding intolerance.

Infants undergoing omphalocele treatment receive initial feedings intravenously while the bowels recover. Once bowel function returns, as evidenced by a successful bowel movement, feedings via a naso-gastric (NG) tube are slowly initiated while IV feeds continue. Pumping and freezing of breast milk is encouraged for NG feeds, if tolerated by the infant. Alternatively, a special alimental formula can also be given. NG feeds are gradually increased, as tolerated, and oral feedings are slowly introduced. As this is a gradual process, infants might experience occasional setbacks, including need for bowel rest or additional surgery.


References


The Childrens Hospital of Philadelphia:

http://www.chop.edu/service/fetal-diagnosis-and-treatment/fetal-diagnoses/omphalocele.html

Short Bowel Syndrome Foundation, Inc.

Jon A Vanderhoof, MD, Rosemary J Young, NP-C-, MS, Andrew E Jablonski, A.A.S