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Abdominal wall defects — gastroschisis and omphalocele
Gastroschisis is exposed bowel without a sac to the right of the umbilicus, usually without other anomalies, but the bowel itself is damaged; omphalocele is a midline sac from which the umbilical cord arises, with associated anomalies and syndromes — so in gastroschisis the outcome depends on the bowel and in omphalocele on the associated anomalies.
Why it matters in the exam
Exam questions ask you to tell the two defects apart (site, sac, associated anomalies, maternal age), choose the first management in the delivery room and know the closure options. In gastroschisis: cover the bowel in a sterile bag, lay the infant on its side, place a gastric tube, give high-volume fluids because of heat and fluid loss, then primary closure or a silo with gradual reduction. In a giant omphalocele (with liver in the sac) the accepted approach is "paint and wait" — an antiseptic agent on the sac until it epithelialises, with later repair of the ventral hernia.
Omphalocele is associated with heart defects, trisomies 13, 18 and 21, Beckwith-Wiedemann syndrome (macroglossia, organomegaly and neonatal hypoglycaemia — check glucose) and pentalogy of Cantrell. Gastroschisis is common in young mothers, and its main associated anomaly is intestinal atresia (about 10%). In both defects maternal serum AFP is raised. Vaginal delivery is possible in most cases of both; caesarean section does not improve outcome in gastroschisis, and caesarean section is considered in a giant omphalocele.
After closure in gastroschisis the bowel recovers slowly: parenteral nutrition sometimes lasts weeks, with a risk of necrotising enterocolitis, short bowel syndrome and catheter infections. "Complex" gastroschisis (with atresia, necrosis or perforation) predicts a long stay and higher mortality. In omphalocele, even after successful closure, follow reflux, feeding problems, pulmonary hypoplasia in large cases and malrotation, which is almost always present in both defects.
Key points
- Gastroschisis: right of the umbilicus, no sac, atresia as the associated anomaly.
- Omphalocele: midline, with a sac, associated anomalies common.
- In gastroschisis: cover, lay on the side, gastric tube and fluids.
- Giant omphalocele — paint and wait.
- Beckwith-Wiedemann — check glucose.
Summary table
| Feature | Gastroschisis | Omphalocele |
|---|---|---|
| Site | Right of the umbilicus, normal cord | Midline, the cord arises from the sac |
| Sac | None; the bowel is exposed and inflamed | A sac of amnion and peritoneum |
| Associated anomalies | Few; intestinal atresia about 10% | Common: heart, trisomies, Beckwith-Wiedemann |
| What decides outcome | Bowel condition, atresia, duration of parenteral nutrition | The associated anomalies and syndromes |
| Treatment | Cover, fluids, primary closure or silo | Small: primary closure; giant: paint and wait |
Free exam questions
מה נכון בגישה הכירורגית לאשכים טמירים י בס נדרום prune belly ? (the question as examined, in Hebrew)
- א. בשל מיקום גבוה של האשכים הכרחי לבצע גישה בטנית
- ב. ניתן לבצע את ינ תוח קבוע האשכים במשולב עם ניתוח לתיקון דופן הבטן יש להביא בחשבון שנפח הבטן הגדול ידרוש לחץ תוך בטני גבוה בעת בצוע לפרוסקופיה
- ג. ולכן על המרדים להכניס צנתר וורידי מרכזי
- ד. בגלל סבוכים נשימתיים ,הניתוח נדחה,, בדרך כלל לגיל מאוחר ולכן יש ירידה בפוריות
תינוק נולד בשבוע 35 עם אומפלוצלה ענקית (giant). הילד נראה דיסמורפי, לא בוצע מעקב הריון סדיר. מה מהבאים נכון לגבי ילד זה והטיפול בו? (the question as examined, in Hebrew)
- א. הניתוח אינו דחוף, ולפני החלטה על ניתוח וסוגו, חובה לקבל את תוצאת בדיקת קריוטיפ לאבחון המום הכרומוזומלי ממנו סובל הילד
- ב. הטיפול הטוב ביותר הוא סגירה ראשונית מיידית תוך ביצוע Ladd's procedure בשל סבירות גבוהה להתפתחות תסביב מעי בעתיד
- ג. טיפול לא ניתוחי תוך יצירת צלקת (Scarification treatment) משפר תחלואה ותמותה
- ד. מיעוט הילדים עם אומפלוצלה יסבלו מהחזר קיבתי-וושטי והשכיחות יורדת ביחס ישר לגודל הפגם
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Sources
- Holcomb and Ashcraft's Pediatric Surgery, 7th edition (2019) — Congenital Abdominal Wall Defects
- Society for Maternal-Fetal Medicine Consult Series: Fetal gastroschisis and omphalocele, 2024 — Prenatal diagnosis and delivery planning
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.