Abdominal Wall Defects-Exomphalos
1.What is Exomphalos?
It is a SURGICAL EMERGENCY which is unique to the neonatal period. It refers to the congenital problem of the abdominal wall, resulting in defects around the umbilical cord, and abnormalities of the gut and even other internal organs inside the tummy.
According to the size of the abdominal wall defect type, there are Exomphalos Minor (small defect) and Exomphalos Major (large defect)
2. Antenatal Counseling in Exomphalos
The technology for prenatal ultrasound examination has become more mature and popular nowadays. When the exomphalos is found, the obstetrician can refer the mothers-to-be and their families to a specialist pediatric surgeon for antenatal counseling. Such counselling helps understand the condition, treatment after birth, and expected long term outcome etc.
3. How to treat newborns with Exomphalos?
Newborns with Exomphalos must be admitted to the Neonatal Intensive Care Unit for newborn infants.
-Prevent neonatal infection, cooling and dehydration – give intravenous fluids and antibiotics.
– Wrap the protruded gut and internal organs using warmed saline gauze and a waterproof, sterile plastic sheet.
-Place gastric tube to reduce the pressure inside the tummy.
–Surgical Repair whenever it is possible. Unless it is a particularly large defect, most can still be repaired at one time.
–Silo Repair if the defect is large. If the gap is too large, the protruded gut & organs must be wrapped with the artificial Silo sheet first, and then the gut should be pushed into the tummy every day until it is fully pushed in, and then the abdominal wall is closed surgically.
4. What is Abdominal Compartment Syndrome?
If the protruded gut & organs are forcefully pushed into a small tummy, the blood supply to these structures may then be blocked resulting in severe & bad reactions of various body systems (Abdominal Compartment Syndrome). If the condition is not reversed right away, it would be fatal to the newborn.