Omphalocele and Gastroschisis

 

 

Background 

 

  • Both are defects of anterior abdominal wall that permit external herniation of abdominal viscera

  • Omphalocele: contents are covered by a sac formed by the peritoneal membrane (up to 3/4 of omphalocele cases are associated with other congenital defects including cardiac anomalies & trisomy 21)

  • Gastroschisis: hernia sac does not cover the herniated abdominal viscera.  Therefore, the bowel is exposed to the external environment 

 

 

Considerations

 

  • Neonate considerations 

  • Sequelae of open abdomen:

    • Aspiration

    • Hypothermia

    • Fluid & electrolyte abnormalities

    • Sepsis

  • Discussion with surgeon regarding primary versus staged closure

  • Abdominal compartment syndrome after closure:

    • Shock/cardiac dysfunction, ↓ venous return

    • Acute kidney injury 

    • Restrictive lung disease/respiratory failure

    • ↓ splanchnic & liver blood flow (prolonged drug effect)

  • Congenital heart disease considerations if present with omphalocele

 

 

Management 

 

  • Needs RSI or awake intubation 

  • Needs muscle relaxation for closure 

  • Arterial line likely needed 

  • Potential for fluid shifts + need for ongoing resuscitation 

  • Avoid hypovolemia, coagulopathy, acidosis, hypothermia 

  • Likely back to NICU intubated 

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