Abdominal wall defects

Definition

Abdominal wall defects are birth (congenital) defects that allow the stomach or intestines to protrude. It occurs when a child's abdomen does not develop fully while in the womb. This allows the intestine to develop outside the abdomen. Early in all pregnancies, the intestine develops inside the umbilical cord and then usually moves inside the abdomen a few weeks later. Occasionally, the intestine stays inside the umbilical cord and so develops outside the abdominal wall. There are various types of abdominal wall defect. If the intestine is contained inside a covering of membrane, this process is called an omphalocele, which can be either small or large. If the intestine is not inside a covering of membrane, this formation is called a gastroschisis.


Demographics

Abdominal wall defects are very rare. Omphalocele occurs in about one in every 3,500 births, and gastroschisis is even more rare. Omphalocele is often associated with other problems. An ultrasound is the best method for the detection of the condition and can occur as early as 11 to 14 weeks of gestation.


Description

Many unexpected and fascinating events occur during the development of a fetus inside the womb. The stomach and intestines begin development outside the baby's abdomen and only later does the abdominal wall enclose them. Occasionally, either the umbilical opening is too large, or it develops improperly, allowing the bowels or stomach to remain outside or squeeze through the abdominal wall.

Causes and symptoms

There are many causes for birth defects that still remain unclear. Presently, the cause(s) of abdominal wall defects is unknown, and any symptoms the mother may have to indicate that the defects are present in the fetus are nondescript.

Diagnosis

At birth, the problem is obvious, because the base of the umbilical cord at the navel bulges or, in worse cases, contain viscera (internal organs). Before birth, an ultrasound examination may detect the problem. It is always necessary in children with one birth defect to look for others, because birth defects are usually multiple.

Treatment

Abdominal wall defects are effectively treated with surgical repair. Unless there are accompanying anomalies, the surgical procedure is not overly complicated. The organs are normal, just misplaced. However, if the defect is large, it may be difficult to fit all the viscera into the small abdominal cavity.

Prognosis

If there are no other defects, the prognosis after surgical repair of this condition is relatively good. However, 10% of those with more severe or additional abnormalities die from it. The organs themselves are fully functional; the difficulty lies in fitting them inside the abdomen. The condition is, in fact, a hernia requiring only replacement and strengthening of the passageway through which it occurred. After surgery, increased pressure in the stretched abdomen can compromise the function of the organs inside.

Prevention

Some, but by no means all, birth defects are preventable by early and attentive prenatal care, good nutrition, supplemental vitamins, diligent avoidance of all unnecessary drugs and chemicals-especially tobacco-and other elements of a healthy lifestyle.