In some cases, for some unknown reason, while in
utero, the abdominal wall muscles do not form correctly.
And, when the abdominal wall is incompletely
formed at birth, the internal organs of the infant can
either protrude into the umbilical cord (omphalocele)
or to the side of the navel (gastroschisis). The size of an
omphalocele varies: some are very small, about the
size of a ping pong ball, while others may be as big as
a grapefruit. Omphalocele repair is performed to
repair the omphalocele defect in which all or part of
the bowel and other internal organs lie on the outside
of the abdomen in a hernia (sac). Gastroschisis repair
is performed to repair the other abdominal wall defect
through which the bowel protrudes with no protective
sac present. Gastroschisis is a life-threatening condition
that requires immediate medical intervention.
Surgery for abdominal wall defects aims to return the
abdominal organs back to the abdominal cavity, and
to repair the defect if possible. It can also be performed
to create a pouch to protect the intestines until they are
inserted back into the abdomen.
Abdominal wall defects occurs in the United States
at a rate of one case per 2,000 births, which means that
some 2,360 cases are diagnosed per year. Mothers
below the age of 20 are four times as likely as mothers
in their late twenties to give birth to affected babies.
Abdominal wall defect surgery is performed soon
after birth. The protruding organs are covered with
dressings, and a tube is inserted into the stomach to
prevent the baby from choking or from breathing in
the contents of the stomach into the lungs. The surgery
is performed under general anesthesia. First, the
pediatric surgeon enlarges the hole in the abdominal
wall in order to examine the bowel for damage or other
birth defects. Damaged portions of the bowel are
removed and the healthy bowel is reconnected with
stitches. The exposed organs are replaced within the
abdominal cavity, and the opening is closed. Sometimes
closure of the opening is not possible, for example
when the abdominal cavity is too small or when the
organs are too large or swollen to close the skin. In
such cases, the surgeon will place a plastic covering
pouch, commonly called a silo because of its shape,
over the abdominal organs on the outside of the infant
to protect the organs. Gradually, the organs are
squeezed through the pouch into the opening and
returned to the body. This procedure