Review Question - QID 105587

This child is suffering from an omphalocele secondary to malformation of his abdominal wall and malrotation of the bowel. Prior to surgical intervention, the omphalocele must be wrapped in a sterile saline dressing to prevent heat and fluid loss.

An omphalocele or gastroschesis are rare congenital birth defects that occur secondary to malformation of the abdominal wall musculature, most often secondary to malrotation of the bowel back into the abdominal cavity. An omphalocele is surrounded by a membranous sac, while in a gastroschisis the bowl is does not have a membranous sac. In an omphalocele the membranous sac protrudes directly out of the umbilicus. Temporizing measures are necessary to support the child and extra-abdominal bowel prior to definitive surgical intervention to return the bowel to the peritoneal sac and reestablish abdominal wall continuity.

Fuloria and Kreiter emphasize the importance of the newborn examination to ensure extra uterine survival. They state that an omphalocele must be adequately covered in saline gauze with aggressive fluid resuscitation and antibiotic use. Surgical consultation is immediately indicated.

Kelly and Ponsky review pediatric abdominal wall defects. They state that omphaloceles occur in 2/10,000 births and gastroschisis occurs in 3/10,000 births. The incidence of pediatric umbilical hernias is between 10 and 30%. These patients must be evaluated for other syndromic diagnoses.

Figure A shows an ultrasound of a fetus with an omphalocele.

Illustration A is a photo of a newborn child with an omphalocele.

Incorrect Answer:
Answer 1: Surgical repair is the definitive treatment, but is not the first step after birth.
Answer 2: Peripheral IV access is needed for antibiotic administration.
Answer 3: OG tube is needed to decompress the stomach, but is not the initial step of treatment.
Answer 4: Broad spectrum antibiotics are indicated once IV access has been achieved.