Abdominal Wall Defects

The first topic we are going to review today are the abdominal wall defects. 

So, we have first umbilical hernia, think of a weak portion in the belly and like a small mass protruding out of it. For this we have to think about number 4, what does it mean? If the hernia is less than 4 cm in size and doesn't have symptoms, we can just keep doing clinical follow up of the kid, but if even being less than 4 cm it present symptoms (like pain) this kid might need surgery. Again number 4, umbilical hernias, usually have to disappear by the age of...yes you did it right by the age of 4. But if we have a kid over 4 years old still with the hernia present, he also might need surgery because of the risk on increasing in size.

The next defect is called omphalocele, this word has Greek origin, where they called Omphalo to the Apollo Temple, being considered as the center Earth. In this type of abdominal defect we will have abdominal content like intestines or liver going outside the body, but in this case all this content is COVERED BY A SAC. Remember that in omphalocele further studies are needed in order to find out if its related with a genetic syndrome.

At last we have gastroschisis, again this word has Greek origin which means division, so again is a problem in the abdominal wall where abdominal content will be going out of the body, but in this case the main difference is the LACK OF SAC, so what does it mean? yes, all the content will be expose to amniotic fluid increasing the risk of adhesions, atresia and strictures with this increasing the need of resecting a section of the intestine (also leading to other problem: short bowel syndrome)

Treatment: for both omphalocele and gastroschisis will be surgery, but in this case the age of surgery will be determined by the size of the defect. If its a small defect can go straight to surgery, but in the other hand if its a big one, the option is create a silo over it, covering the lesion and returning it gradually to the abdominal cavity, why gradually? Imagine trying to put a melon inside an orange, hard right? well the same happens when you try to put a large lesion back to abdominal cavity, in this case will increase the risk of death of the patient because of respiratory failure (huge lesion make hard to breath!)

Next you can find a video for this lesson, I hope you enjoy it.

See you in the next topic,

Carlos Albrecht