DOCSLIB.ORG

Abdominal Wall Defects—Current Treatments

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Abdominal Wall Defects—Current Treatments children Review Abdominal Wall Defects—Current Treatments Isabella N. Bielicki 1, Stig Somme 2, Giovanni Frongia 3, Stefan G. Holland-Cunz 1 and Raphael N. Vuille-dit-Bille 1,* 1 Department of Pediatric Surgery, University Children’s Hospital of Basel (UKBB), 4056 Basel, Switzerland; [email protected] (I.N.B.); [email protected] (S.G.H.-C.) 2 Department of Pediatric Surgery, University Children’s Hospital of Colorado, Aurora, CO 80045, USA; [email protected] 3 Section of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, 69120 Heidelberg, Germany; [email protected] * Correspondence: [email protected]; Tel.: +41-61-704-27-98 Abstract: Gastroschisis and omphalocele reflect the two most common abdominal wall defects in newborns. First postnatal care consists of defect coverage, avoidance of fluid and heat loss, fluid administration and gastric decompression. Definitive treatment is achieved by defect reduction and abdominal wall closure. Different techniques and timings are used depending on type and size of defect, the abdominal domain and comorbidities of the child. The present review aims to provide an overview of current treatments. Keywords: abdominal wall defect; gastroschisis; omphalocele; treatment 1. Gastroschisis Citation: Bielicki, I.N.; Somme, S.; 1.1. Introduction Frongia, G.; Holland-Cunz, S.G.; Gastroschisis is one of the most common congenital abdominal wall defects in new- Vuille-dit-Bille, R.N. Abdominal Wall borns. Children born with gastroschisis have a full-thickness paraumbilical abdominal Defects—Current Treatments. wall defect, which is associated with evisceration of bowel and sometimes other organs Children 2021, 8, 170. https:// (Figure1a). The defect typically measures 2–3 centimeters and is thought to result from doi.org/10.3390/children8020170 involution of the right umbilical vein. Hence, the defect is mostly located to the right of the umbilical cord [1]. The prevalence of gastroschisis has decreased to baseline from 2009 Academic Editor: Piotr Kalici´nski through 2018 after increasing from 2–3 per 10,000 in 1995 to 4–5 per 10,000 in 2005 [2–7]. Risk factors associated with gastroschisis include maternal smoking, illicit drug use, alcohol Received: 23 January 2021 consumption, young maternal age, environmental factors, socio-economic status, opioid Accepted: 15 February 2021 Published: 23 February 2021 prescription rates and others [8–10]. It seems likely that changes in gastroschisis prevalence result from changes in risk factor prevalence. Gastroschisis is typically accompanied by intestinal non-rotation and may be associated with intestinal atresia and/or perforations. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in In contrast to omphalocele, gastroschisis is rarely associated with other congenital or chro- published maps and institutional affil- mosomal anomalies [11]. As the midgut is freely floating in the amniotic fluid, the intestine iations. is typically thickened, edematous and foreshortened [12]. 1.2. Complex Gastroschisis Complex (as compared to simple) gastroschisis occurs in about 11–28% of cases and is defined by the presence of intestinal complications including atresia, perforation or Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. necrosis. Intestinal atresia is the most common anomaly associated with gastroschisis This article is an open access article occurring in about 10–15% of patients [11–14]. distributed under the terms and Complex gastroschisis is associated with increased morbidity and mortality lower- conditions of the Creative Commons ing survival rate from >90% to 70–80% in developed countries [15]. Length of stay is Attribution (CC BY) license (https:// dramatically prolonged in complex gastroschisis [16]. creativecommons.org/licenses/by/ 4.0/). Children 2021, 8, 170. https://doi.org/10.3390/children8020170 https://www.mdpi.com/journal/children Children 2021,, 8,, 170x FOR PEER REVIEW 2 2of of 18 17 FigureFigure 1. Gastroschisis:Gastroschisis: ( a) Herniated intestine andand greatergreater omentum;omentum; ( b(b)) Silo Silo treatment; treatment; ( c()c) Abdomi- Ab- dominalnal wall afterwall after sutured sutured closure; closure; (d) Sutureless (d) Sutureless closure. closure. 1.2. ComplexThe abdominal Gastroschisis wall defect may shrink during the last trimester (referred to as closing gastroschisis), this can lead to compression of the herniated viscera resulting in intestinal obstructionComplex and/or (as compared mesenteric to simple) ischemia. gastroschisis In rare cases, occurs a complete in about closure 11%– of28% the of abdominal cases and iswall defined at birth by the can presence be observed. of intestinal This is complications referred to as including closed gastroschisis. atresia, perforation As a result,or ne- crosis.secondary Intestinal atresia, atresia the presence is the most of only common rudimentary anomaly herniated associated viscera with orgastroschisis the complete occur- loss ringof the in herniatedabout 10% bowel–15% (referredof patients to [11 as– vanishing14]. gastroschisis) may occur [17]. It is hence crucialComplex to detect gastroschisis signs of abdominal is associat walled with closure increased in utero. morbidity and mortality lowering survival rate from >90% to 70%–80% in developed countries [15]. Length of stay is dra- matically1.3. Diagnostic prolonged Approach in complex and Prenatal gastroschisis Management [16]. TheGastroschisis abdominal is wall typically defect diagnosed may shrink by ultrasoundduring the duringlast trimester the second (refer trimesterred to as anomaly closing gastroschisis),scan, at around this 20 weekscan lead gestational to compression age (WGA). of the In herniated contrast toviscera omphalocele, resulting the in herniatedintestinal obstructionbowel floats and/or freely mesenteric in the amniotic ischemia. cavity In rare and cases, is not a coveredcomplete by closure a membranous of the abdominal hernia wallsac [ 18at ].birth First can trimester be observed. diagnosis This of is gastroschisis referred to as is closed unreliable, gastroschisis. as early ultrasoundAs a result, diag- sec- ondarynosis can atresia, be confounded the presence by of the only physiologic rudimentary midgut herniated herniation viscera leading or the tocomplete false positive loss of theresults herniated [19]. As bowel physiologic (referred midgut to as herniation vanishing is gastroschisis) still present until may 12 occur WGA [17]. in up It tois 20%hence of crucialfetuses, to prenatal detect signs diagnosis of abdominal of gastroschisis wall closure earlier in inutero. pregnancy needs hence to be inter- preted cautiously. The prenatal diagnosis of gastroschisis should be differentiated from 1.3.other Diagnostic ventral abdominal Approach and wall P defects,renatal M asanagement management and treatment differ between entities. EspeciallyGastroschisis in the unusualis typically cases diagnosed of in utero by rupture ultrasound of the during omphalocele the second sac, distinction trimester anomalybetween gastroschisesscan, at around and 20 omphalocele weeks gestational may be age difficult. (WGA). Furthermore, In contrast to liver omphalocele, herniation—a the herniatedtypical sign bowel of omphalocele—has floats freely in the also amniotic been described cavity and in is cases not covered of gastroschisis by a membranous with large herniadefects sac [1]. [18]. In contrast, First trimester elevation diagnosis of Alpha of gastroschisis Fetoprotein (AFP)is unreliable, in maternal as early serum ultrasound is more diagnosislikely to be can observed be confounded in pregnancies by the physiologic with gastroschisis midgut asherniation compared leading to omphalocele to false posi- [1]. tiveAfter results in utero [19]. diagnosis As physiologic of an abdominal midgut herniation wall defect is still (gastroschisis present until or omphalocele),12 WGA in up the to 20%care of of fetuses, the pregnant prenatal mother diagnosis should of gastroschisis be transferred earlier to a in tertiary pregnancy care centerneeds hence for further to be interpretedcounselling cautiously. and treatment The by prenatal an interdisciplinary diagnosis of team gastroschisis encompassing should obstetricians, be differentiated neona- fromtologists other and ventral pediatric abdominal surgeons wall [18 ].defects, Serial ultrasoundsas management are performed and treatment to evaluate differ between different entities.intestinal Especially outcome in parameters the unusual (including cases of intestinalin utero rupture dilation of and the bowel omphalocele wall thickening), sac, dis- tinctionthe amount between of amniotic gastroschises fluid and and growth omphalocele of the fetus may [ 18be]. difficult. Dilation Furth of theermore, intra- (not liver extra-) her- niationabdominal—a typical bowel, sign as well of omphalocele as the presence—has of also polihydramnios been described are in typicallycases of gastroschisis observed in withcomplex large gastroschisis defects [1]. In (with contrast, intestinal elevation atresia). of Alpha Gastric Fetoprotein dilation ( mayAFP)be in associatedmaternal serum with isincreased more likely mortality to be [18 ].observed An increasing in pregnancies dilation of thewith small gastroschisis bowel could as indicate compared closing to Children 2021, 8, 170 3 of 17 gastroschisis, which necessitates premature delivery in order to avoid loss of the herniated viscera (i.e., vanishing gastroschisis)
Load more

Recommended publications
  • Abdominal Wall Defect
    Abdominal wall defect Description An abdominal wall defect is an opening in the abdomen through which various abdominal organs can protrude. This opening varies in size and can usually be diagnosed early in fetal development, typically between the tenth and fourteenth weeks of pregnancy. There are two main types of abdominal wall defects: omphalocele and gastroschisis. Omphalocele is an opening in the center of the abdominal wall where the umbilical cord meets the abdomen. Organs (typically the intestines, stomach, and liver) protrude through the opening into the umbilical cord and are covered by the same protective membrane that covers the umbilical cord. Gastroschisis is a defect in the abdominal wall, usually to the right of the umbilical cord, through which the large and small intestines protrude (although other organs may sometimes bulge out). There is no membrane covering the exposed organs in gastroschisis. Fetuses with omphalocele may grow slowly before birth (intrauterine growth retardation) and they may be born prematurely. Individuals with omphalocele frequently have multiple birth defects, such as a congenital heart defect. Additionally, underdevelopment of the lungs is often associated with omphalocele because the abdominal organs normally provide a framework for chest wall growth. When those organs are misplaced, the chest wall does not form properly, providing a smaller than normal space for the lungs to develop. As a result, many infants with omphalocele have respiratory insufficiency and may need to be supported with a machine to help them breathe ( mechanical ventilation). Rarely, affected individuals who have breathing problems in infancy experience recurrent lung infections or asthma later in life.
    [Show full text]
  • Hospital Readmission Among Infants with Gastroschisis
    Journal of Perinatology (2011) 31, 546–550 r 2011 Nature America, Inc. All rights reserved. 0743-8346/11 www.nature.com/jp ORIGINAL ARTICLE Hospital readmission among infants with gastroschisis AP South1,2, JJ Wessel1,2, A Sberna1, M Patel1 and AL Morrow1 1Division of Neonatology, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA and 2Intestinal Rehabilitation Program, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA Introduction Objective: Infants with gastroschisis have significant perinatal morbidity Gastroschisis is a congenital abdominal wall defect that results in including long hospitalizations and feeding intolerance. Two thirds are evisceration of the bowel into the amniotic space. The birth premature and 20% are growth restricted. Despite these known risk factors prevalence is increasing, affecting B4.5 per 10 000 births.1 While for post-natal complications, little is known about readmission for infants in-hospital morbidity and mortality are well described, there is with gastroschisis. Our objective was to determine the frequency and limited information regarding post-discharge outcomes. Infants indication for hospital readmission after initial discharge among infants with gastroschisis have multiple risk factors for poor long-term with gastroschisis. outcome, including prematurity in two thirds,2 and poor in utero Study Design: Retrospective cohort study. All surviving infants treated growth in 20%.3 Despite absence of extreme prematurity in most for gastroschisis at Cincinnati Children’s Hospital Medical Center, born cases, all infants with gastroschisis are at risk for the development between January 2006 and December 2008 were included. Main outcome of necrotizing enterocolitis with subsequent bowel injury or loss.
    [Show full text]
  • 11 Visceral and Parietal Anomalies
    6505 BIOL 5720 − INTRODUCTION TO FETAL MEDICINE 11. VISCERAL AND PARIETAL ANOMALIES Arlet G. Kurkchubasche, M.D. Francois I. Luks, M.D. ABDOMINAL WALL DEFECTS Definitions - Omphalocele (also called exomphalos) § Defect is central, involving the umbilicus § Often covered by a membrane, “protecting” viscera; membrane may be ruptured § >30 % have associated anomalies - Chromosomal anomalies: trisomy 18 - “Upper midline” defects: Pentalogy of Cantrell (including heart, pericardium, pleural) - “Lower midline” defects: cloacal exstrophy § Etiology: depends on type; unclear - Gastroschisis (laparoschisis) § Defect is always too the side of an intact umbilicus; usually right of midline § Never covered by a membrane § Associated anomalies are rare, except (presumably secondary) intestinal ones (atresia) § Correlation with young maternal age § 4-5 times more common than omphalocele Diagnosis - Ultrasound very sensitive, and highly specific: § Position of defect and umbilical cord insertion (omphalocele vs. gastroschisis) § Difficult < 16 weeks; not possible < 12 weeks (‘physiologic’ omphalocele at 8-11 wk) § Importance of finding associated anomalies: - Chromosomal (amniocentesis) (omphalocele) - Heart, bladder, pelvis (exstrophy), limbs: omphalocele - Major limb/body wall deformities: rare form of severe amniotic band syndrome sometimes associated with gastroschisis – highly lethal 1 BIOL 6505 § Gastrointestinal anomalies: intestinal loop distension not specific/sensitive for atresia § Grading: “giant” omphalocele contains liver; small omphalocele = “hernia of the cord” - Alpha-fetoprotein (AFP) elevated (amniotic fluid and maternal serum): reflects ‘leakage’ of body proteins through any breach in fetal skin: gastroschisis, spina bifida Prenatal management - Alterations in time, place and mode of delivery § Decision to deliver in tertiary center (with neonatal ICU and surgical services) § C/Section:usually not necessary, except for giant omphalocele (liver trauma) § Early delivery: - Controversial.
    [Show full text]
  • Gastro-Esophageal Reflux in Children
    International Journal of Molecular Sciences Review Gastro-Esophageal Reflux in Children Anna Rybak 1 ID , Marcella Pesce 1,2, Nikhil Thapar 1,3 and Osvaldo Borrelli 1,* 1 Department of Gastroenterology, Division of Neurogastroenterology and Motility, Great Ormond Street Hospital, London WC1N 3JH, UK; [email protected] (A.R.); [email protected] (M.P.); [email protected] (N.T.) 2 Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Napoli, Italy 3 Stem Cells and Regenerative Medicine, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK * Correspondence: [email protected]; Tel.: +44(0)20-7405-9200 (ext. 5971); Fax: +44(0)20-7813-8382 Received: 5 June 2017; Accepted: 14 July 2017; Published: 1 August 2017 Abstract: Gastro-esophageal reflux (GER) is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD). Although the pathophysiology is similar to that of adults, symptoms of GERD in infants and children are often distinct from classic ones such as heartburn. The passage of gastric contents into the esophagus is a normal phenomenon occurring many times a day both in adults and children, but, in infants, several factors contribute to exacerbate this phenomenon, including a liquid milk-based diet, recumbent position and both structural and functional immaturity of the gastro-esophageal junction. This article focuses on the presentation, diagnosis and treatment of GERD that occurs in infants and children, based on available and current guidelines.
    [Show full text]
  • Omphalocele Handout
    fetal treatment PROGRAM OF NEW ENGLAND Hasbro Children’s Hospital | Women & Infants Hospital | Brown University Omphalocele What is omphalocele? Omphalocele is a condition in which loops of intestines (and sometimes parts of the stomach, liver and other organs) protrude from the fetus’s body through a hole in the abdominal wall. The hole is located at the belly button and is covered by a membrane, which provides some protection for the exteriorized organs. The umbilical cord inserts at the top of this membrane rather than on the abdomen itself. Omphalocele is often confused with gastroschisis, a similar condition in which the hole in the abdominal wall is located to the side (usually the left) of the umbilical cord. Omphaloceles come in all sizes: they may only contain one or two small loops of intestine and resemble an umbilical hernia, or they may be much larger and contain most of the liver. These are called “giant” omphalocele and are more difficult to treat. How common is it? Omphalocele occurs in approximately one in 5,000 births and is associated with other conditions and chromosomal anomalies in 50 percent of cases. How is it diagnosed? Omphalocele can be detected through ultrasound from 14 weeks of gestation; however, it is easier to diagnose as the pregnancy progresses and organs can be seen outside the abdomen protruding into the amniotic cavity. Because of the high risk of associated conditions, a prenatal test called an amniocentesis may be performed to help detect chromosomal and heart anomalies. • Amniocentesis: Under ultrasound guidance, a fine needle is inserted through the abdomen into the uterus.
    [Show full text]
  • Megaesophagus in Congenital Diaphragmatic Hernia
    Megaesophagus in congenital diaphragmatic hernia M. Prakash, Z. Ninan1, V. Avirat1, N. Madhavan1, J. S. Mohammed1 Neonatal Intensive Care Unit, and 1Department of Paediatric Surgery, Royal Hospital, Muscat, Oman For correspondence: Dr. P. Manikoth, Neonatal Intensive Care Unit, Royal Hospital, Muscat, Oman. E-mail: [email protected] ABSTRACT A newborn with megaesophagus associated with a left sided congenital diaphragmatic hernia is reported. This is an under recognized condition associated with herniation of the stomach into the chest and results in chronic morbidity with impairment of growth due to severe gastro esophageal reflux and feed intolerance. The infant was treated successfully by repair of the diaphragmatic hernia and subsequently Case Report Case Report Case Report Case Report Case Report by fundoplication. The megaesophagus associated with diaphragmatic hernia may not require surgical correction in the absence of severe symptoms. Key words: Congenital diaphragmatic hernia, megaesophagus How to cite this article: Prakash M, Ninan Z, Avirat V, Madhavan N, Mohammed JS. Megaesophagus in congenital diaphragmatic hernia. Indian J Surg 2005;67:327-9. Congenital diaphragmatic hernia (CDH) com- neonate immediately intubated and ventilated. His monly occurs through the posterolateral de- vital signs improved dramatically with positive pres- fect of Bochdalek and left sided hernias are sure ventilation and he received antibiotics, sedation, more common than right. The incidence and muscle paralysis and inotropes to stabilize his gener- variety of associated malformations are high- al condition. A plain radiograph of the chest and ab- ly variable and may be related to the side of domen revealed a left sided diaphragmatic hernia herniation. The association of CDH with meg- with the stomach and intestines located in the left aesophagus has been described earlier and hemithorax (Figure 1).
    [Show full text]
  • Pediatric Gastroesophageal Reflux Clinical Practice
    SOCIETY PAPER Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition ÃRachel Rosen, yYvan Vandenplas, zMaartje Singendonk, §Michael Cabana, jjCarlo DiLorenzo, ôFrederic Gottrand, #Sandeep Gupta, ÃÃMiranda Langendam, yyAnnamaria Staiano, zzNikhil Thapar, §§Neelesh Tipnis, and zMerit Tabbers ABSTRACT This document serves as an update of the North American Society for Pediatric INTRODUCTION Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European n 2009, the joint committee of the North American Society for Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Pediatric Gastroenterology, Hepatology, and Nutrition (NASP- 2009 clinical guidelines for the diagnosis and management of gastroesophageal GHAN)I and the European Society for Pediatric Gastroenterology, refluxdisease(GERD)ininfantsandchildrenandisintendedtobeappliedin Hepatology, and Nutrition (ESPGHAN) published a medical posi- daily practice and as a basis for clinical trials. Eight clinical questions addressing tion paper on gastroesophageal reflux (GER) and GER disease diagnostic, therapeutic and prognostic topics were formulated. A systematic (GERD) in infants and children (search until 2008), using the 2001 literature search was performed from October 1, 2008 (if the question was NASPGHAN guidelines as an outline (1). Recommendations were addressed
    [Show full text]
  • Gastroschisis and Omphalocele
    Gastroschisis and Omphalocele The two most common congenital abdominal wall At delivery, the ABC (airway, breathing, circulation) rule defects are gastroschisis and omphalocele. Both involve should be followed for babies with gastroschisis or incomplete closure of the abdominal wall during fetal omphalocele. Immediately afterward, protection of the development, and for both, their cause is unknown. A herniated contents and management of evaporative loss gastroschisis is usually an isolated congenital defect, should be accomplished. Abdominal contents should be whereas a baby with an omphalocele often has chromo- wrapped in warm, saline-soaked gauze and covered with some anomalies, cardiac conditions, and other major birth plastic wrap. Alternatively, the baby should be placed in defects. a sterile bowel bag up to the nipple line. Preventing evap- orative fluid loss is particularly important for the baby A gastroschisis is a herniation of abdominal contents with gastroschisis because of the lack of the protective through a defect in the abdominal wall, usually just to the membranous covering of the abdominal contents. Dili- right of the umbilicus. An omphalocele is a herniation of gent observation of the color and perfusion of the abdom- abdominal contents into the umbilical cord itself. The con- inal contents of a baby with gastroschisis is imperative. tents of a gastroschisis are directly exposed to amniotic The baby should be placed on his or her right side with fluid, whereas the contents of an omphalocele are usually abdominal contents supported with additional gauze or covered with a protective membranous sac. blankets to prevent kinking of the mesentery blood ves- sels. An echocardiogram also should be considered to rule out potential cardiac anomalies (Escobar & Caty, 2016).
    [Show full text]
  • Human Milk Versus Formula After Gastroschisis Repair: Effects on Time to Full Feeds and Time to Discharge
    Journal of Perinatology (2013) 33, 627–630 & 2013 Nature America, Inc. All rights reserved 0743-8346/13 www.nature.com/jp ORIGINAL ARTICLE Human milk versus formula after gastroschisis repair: effects on time to full feeds and time to discharge JA Kohler Sr, AM Perkins and WT Bass OBJECTIVE: To determine if the choice of enteral feeds after gastroschisis repair relates to the time to achieve full feeds and time to discharge. STUDY DESIGN: A retrospective study of infants with gastroschisis from 2000 to 2010 examined demographics, days at closure, days at initiation of feeds, days to full feeds, time to discharge and length of stay. RESULT: Ninety infants were identified, 22 received (human milk) HM exclusively, 15 were fed 450% HM, 16 were fed o50% HM and 26 were fed only cow milk-based formulas. Infants fed exclusively HM had significantly shorter times to full enteral feedings (median 5 days versus 7 days, P ¼ 0.03). The time from initiation of feedings to hospital discharge, which accounts for initiation age, significantly favored the exclusively HM-fed infants (median 7 days versus 10 days, P ¼ 0.01). CONCLUSION: Exclusive HM feeding after gastroschisis repair decreases time to achieve full enteral feeds and time to discharge. Journal of Perinatology (2013) 33, 627–630; doi:10.1038/jp.2013.27; published online 21 March 2013 Keywords: total parenteral nutrition; parenteral nutrition-associated liver disease; intestinal permeability INTRODUCTION METHODS Gastroschisis is a congenital defect of the ventral abdominal wall. Study population The lesion consists of a small full-thickness periumbilical cleft This retrospective study included all patients who were admitted to the usually to the right of the umbilicus, which allows for the neonatal intensive care unit of the Children’s Hospital of The King’s herniation of abdominal contents into the amniotic sac.
    [Show full text]
  • Gastroschisis
    Gastroschisis This guideline was updated in May 2015 by Dr Renuka Bhat with input from members of the New Zealand Maternal Fetal Medicine Network. Background Fetal gastroschisis is usually often diagnosed at Nuchal translucency or routine anomaly scan. Underlying cause is still unknown, but is believed to be related to vascular compromise of the omphalomesenteric artery during embryonic development. Numerous studies have reported a rising incidence of gastroschisis. Risk factors include young maternal age, smoking and use of vasoactive agents. A survival rate of liveborn infants with gastroschisis is 90 – 95%. The risk of intra-uterine fetal death is about 10% and its association with fetal distress is well known. Once the diagnosis is clarified (where possible) options can be discussed with the woman and her support. If the woman continues the pregnancy, continued care with fetal medicine input/ LMC is indicated. The follow-up will depend on the situation. 2015 May Gastroschisis: Objective To guide the accurate diagnosis, investigation and management of women presenting with fetal gastroschisis. To provide a consistent approach to the care of women with fetal gastroschisis which takes into consideration individual women’s views and wishes regarding care plan. 2 Definition • Fetal gastroschisis is defined as full thickness anterior abdominal wall defect with bowel protruding through the defect • It usually occurs on the right side of a normally inserting umbilical cord • The defect is not covered by membrane Differential Diagnosis • Omphalocele and associated syndromes (e.g. Beckwith-Wiedermann, pentalogy of Cantrell) • Amniotic banding • Limb- body wall complex Important History • Age and ethnicity Gastroschisis: May 2015 May Gastroschisis: • Any drug use particularly vaso-active drugs • Past obstetric history, any anomalies / syndromes • Any family history of note.
    [Show full text]
  • GERD in Children: an Update
    Review articles GERD in children: an update Carlos Alberto Velasco Benítez, MD.1 1 Pediatrician, Gastroenterologist, Nutritionist, Abstract University teaching specialist, Msc. in Epidemiology, Professor and Director of the GASTROHNUP Although the definition of Gastro-Esophageal Reflux Disease (GERD) has not changed much over the last Research Steering Group at the Universidad del Valle ten years, GERD continues to cause high rates of morbidity and mortality. Probably, and in a practical way, it in Cali, Colombia could be said that physiological GERD that is not pathological is usually accompanied by regurgitation, and ......................................... that its main symptom is vomiting. As in acid peptic disease, in GERD we can talk about certain aggressi- Received: 10-08-11 ve and protective factors that can cause damage depending on their prevalence. Signs and symptoms of Accepted: 19-12-13 GERD in children depend on the age of the group studied. Just as every wheezing child is not asthmatic, in gastroenterology not every child that vomits or regurgitates has GERD. Today, certain slowly evolving diseases and conditions are defined as refractory GERD because the natural history of these diseases and their association with increased morbidity and mortality result in prognoses that imply different therapeutic approaches. Sensitivity, specificity and reproducibility vary in accordance to the laboratory tests requested to study a child with GERD. Treatment of children with GERD includes anti-reflux measures, administration of medicine and surgery. Key words Update, Gastro-Esophageal Reflux Disease, children. INTRODUCTION of respiratory complications such as irrecoverable massive bronchoaspiration. The purpose of this study to review Gastro-Esophageal Reflux Disease (GERD) is nothing articles concerning GERD in children published in the last but the return of gastric contents into the esophagus.
    [Show full text]
  • Management of Omphalocele with Intestinal Perforation: a Case Report
    Journal of Pediatrics and Neonatal Care Management of Omphalocele with Intestinal Perforation: A Case Report Abstract Case Report Volume 2 Issue 6 - 2015 Congenital abdominal wall defects present a huge challenge for pediatric surgeons in the care of neonates. The risks of infection and restriction of blood supply to Hector Quintero, Ortiz-Justiniano V*, Zasha abdominal organs challenge the surgeons’ capacity to restore the stability of the Vazquez and Ada Rivera patient. Omphalocele is a defect of the abdominal wall where the organs protrude University of Puerto Rico Medical Sciences Campus, Puerto enclosed within a membranous sac. Carrying a mortality rate of 34%, an incidence Rico of 1 in 4,000 live births and being more common in males than in females [1,2] makes it more difficult for the surgeon to manage complications. There are few *Corresponding author: Ortiz-Justiniano V, Puerto Rico reports of intestinal perforation in patients with omphalocele [3]. We report the case of a 2-days-old boy who presented with omphalocele that required surgical Childrens Hospital Ofic. 302 Carr Num. 2, Km 11.7 Edif. excision of the membranous sac for management of intestinal perforation as a life Medical Plaza Bayamon, PR 00960, Puerto Rico, Tel: 787- Keywords:saving procedure. 474-5423; Fax: 787-523-2768; Email: Congenital abdominal wall defect; Omphalocele; Intestinal Received: June 11, 2015 | Published: perforation; Neonate; Spring-loaded silo September 8, 2015 Abbreviations: WGA: Weeks of Gestational Age; NICU: common technique used nowadays is daily application of silver Neonatal Intensive Care Unit; NGT: French Nasogastric Tube; sulfadiazine covered by cotton free gauze and elastic bandage.
    [Show full text]