*3.4.2 Clinical presentation*

Numerous physical characteristics differentiate omphalocele from gastroschisis. The abdominal wall defect in omphalocele is midline, versus to the right of the umbilicus in gastroschisis. Defects tend to be smaller in gastroschisis, typically ≤3 cm. In comparison, omphaloceles can vary widely in diameter, ranging in size from 2 to 15 cm. Larger defects allow for herniation of more organs, namely the liver and spleen. This rarely, if at all, occurs in gastroschisis. Herniated contents are covered by an amniotic sac in omphalocele but not in gastroschisis. Exposure of the bowel to amniotic fluid during gestation causes the bowel to become thickened and the mesentery fibrotic whereas bowel is normal in omphalocele since it is protected by the overlying sac. Lastly, omphalocele has a higher association with chromosomal abnormalities and other congenital anomalies compared gastroschisis. Intestinal atresia may be seen in gastroschisis.

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anesthesia.

*3.4.5 Outcomes*

*3.4.3 Diagnosis*

**Figure 6.**

*3.4.4 Surgical management*

*side of umbilicus and are not covered.*

*Congenital Anomalies of the Gastrointestinal Tract DOI: http://dx.doi.org/10.5772/intechopen.92588*

These defects may be appreciated on pre-natal ultrasound and are therefore expected upon delivery. Chest radiography, echocardiogram and renal ultrasound are performed to rule out associated anomalies in the case of omphalocele, as is

*Omphalocele (left) and gastroschisis (right). The herniated intestine is covered with a sac with umbilical cord attached to it in omphalocele, while the intestinal loops in gastroschisis herniate through a defect on the right* 

Exposure of intestinal contents to the environment can result in significant insensible losses. Initial management aims to maintain adequate volume status and body temperature. The infant is placed under a warmer, fluid resuscitation commenced, and urinary catheter inserted to strictly monitor volume status. Oro- or naso-gastric tube is placed for bowel decompression. Intestinal contents are wrapped in a moist, sterile plastic dressing to prevent evaporative losses. In the case of omphalocele, care must be taken to prevent rupture of the protective sac. The goals of operation are to return the herniated contents into the abdominal cavity and close the defect. If this is unable to be accomplished either because the infant is too unstable to be taken to the operating room or because there is high risk of abdominal compartment syndrome, a silo can be sutured in place over the herniated viscera and contents gradually reduced. Daily manual reduction can be performed bedside, gently as tolerated, with complete reduction usually achieved over 3–7 days. The resultant ventral hernia is repaired once all viscera have been reduced and the infant deemed fit to tolerate general

Given the protective nature of the overlying sac in omphalocele, infants typically have normal bowel function following reduction and abdominal wall repair. Long term complications are related to concomitant congenital defects. In contrast, patients with gastroschisis, especially if they also have intestinal atresia, are subject to dysmotility, malabsorption and are at increased risk of developing

karyotyping though this may have been performed prenatally.

*Congenital Anomalies of the Gastrointestinal Tract DOI: http://dx.doi.org/10.5772/intechopen.92588*

**Figure 6.**

*Congenital Anomalies in Newborn Infants - Clinical and Etiopathological Perspectives*

years. There is a male predominance. The bleeding is typically brisk and bright red. Laboratory values will demonstrate anemia. A fibrous cord connecting the diverticulum to the abdominal wall may be present and can act as a point around which bowel can obstruct, twist or intussuscept. In such cases, the child will present with abdominal pain and distention, inability to pass flatus or move their

Technetium-99 pertechnate scintigraphy ("Meckel's scan") localizes the bleeding ulcer. The diverticulum is typically found within 2 feet proximal to the ileocecal valve, on the anti-mesenteric side of the ileum and contains heterotopic mucosa, usually that of gastric or pancreatic in origin. Ulceration and bleeding occur secondary to acid secretion from the heterotopic mucosa. It is a true diverticulum

If bleeding is the presenting symptom, ileal resection with primary anastomosis

Resection of Meckel's diverticulum has an excellent prognosis without major

These are congenital defects of the abdominal wall, not of the gastrointestinal tract itself, but are discussed because they are associated with malrotation

Numerous physical characteristics differentiate omphalocele from gastroschisis. The abdominal wall defect in omphalocele is midline, versus to the right of the umbilicus in gastroschisis. Defects tend to be smaller in gastroschisis, typically ≤3 cm. In comparison, omphaloceles can vary widely in diameter, ranging in size from 2 to 15 cm. Larger defects allow for herniation of more organs, namely the liver and spleen. This rarely, if at all, occurs in gastroschisis. Herniated contents are covered by an amniotic sac in omphalocele but not in gastroschisis. Exposure of the bowel to amniotic fluid during gestation causes the bowel to become thickened and the mesentery fibrotic whereas bowel is normal in omphalocele since it is protected by the overlying sac. Lastly, omphalocele has a higher association with chromosomal abnormalities and other congenital anomalies compared gastroschisis. Intestinal atresia may be seen in

is the procedure of choice. Segmental resection is also indicated in cases complicated by diverticulitis, perforation, obstruction, volvulus or if the base of the diverticulum is very wide. Simple diverticulectomy may be performed if the neck of

the diverticulum is narrow, or if diverticulitis does not involve the base.

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gastroschisis.

bowels.

*3.3.3 Diagnosis*

*3.3.5 Outcomes*

*3.4.1 Embryology*

*3.4.2 Clinical presentation*

(**Figure 6**).

involving all four layers of the bowel.

long term post-operative complications.

**3.4 Omphalocele and gastroschisis**

*3.3.4 Surgical management*

*Omphalocele (left) and gastroschisis (right). The herniated intestine is covered with a sac with umbilical cord attached to it in omphalocele, while the intestinal loops in gastroschisis herniate through a defect on the right side of umbilicus and are not covered.*
