*3.4.3 Diagnosis*

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 karyotyping though this may have been performed prenatally.

#### *3.4.4 Surgical management*

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 anesthesia.

#### *3.4.5 Outcomes*

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

necrotizing enterocolitis. These infants often require long term parenteral nutrition following surgical correction.
