Abdominal wall defect

Last updated
Abdominal wall defect
Specialty Medical genetics   OOjs UI icon edit-ltr-progressive.svg

Abdominal wall defects are a type of congenital defect that allows the stomach, the intestines, or other organs to protrude through an unusual opening that forms on the abdomen. [1] [2]

Contents

During the development of the fetus, many unexpected changes occur inside the womb. Specifically, the stomach, intestines, or other organs begin to develop outside the fetus' abdomen through the abnormal hole in the abdomen and, as development progresses, the abdominal wall eventually encloses these organs. In some cases of defect either the umbilical opening is too oversized or has developed improperly which allows the organs to remain outside or to squeeze through the abdominal wall. [1]

There are two main types of abdominal wall defects that result due to the changes during development. They are omphalocele and gastroschisis. Gastroschisis develops when the abdominal wall does not completely close, and the organs are present outside of the infant's body. Omphalocele occurs when some of the organs protrude through the muscles of the abdomen in the area surrounding the umbilical cord. Omphalocele can be either minor, with only some of the organs exposed, or severe, with most, if not all of the abdominal organs being exposed. [1]

Presentation

Complications

Concerns that arise due to abdominal wall defects can be threatening and require immediate and intensive medical care. Some infections may persist for long periods of time and lead to serious complications, such as feeding problems, which can cause the infant to require several surgeries. Since these complications can be severe, it is recommended that parents work closely with a team of physicians throughout the duration of the treatment. After the treatment is completed, children with abdominal wall defects may need additional help. Additional services are usually necessary for with omphalocele and the associated chromosomal abnormalities and birth defects that also arise. Treatments in these cases are long-term and focus on the physical and developmental difficulties that the children will endure. The parents may find this process difficult and need assistance in dealing with the process by a service that is provided by the healthcare team. [1]

Cause

Out of all of the causes of birth defects information about a great number is still unknown. As of 2004, the reason that abdominal wall defects occur has yet to be determined or understood. The symptoms that the mother may present that would indicate the development of the defect and unnoticeable . [1] Most cases of abdominal wall defects have been found to be sporadic and have no relationship with the history of the disorder within the family. [3]

The EPA is aware that a common herbicide called Atrazine causes abdominal wall defects as well as other birth defects and cancer. Atrazine has been banned in the EU since 2004, yet is still commonly used in the US despite the evidence of harm. Atrazine affects the drinking water supply, most predominantly in the midwest.[ citation needed ]

The Center for Disease Control and Prevention did a study on the relationship between Atrazine and abdominal wall defects: [4]

"Gastroschisis and omphalocele are congenital abdominal wall defects (AWD). Atrazine and nitrates are common agricultural fertilizers"

and concluded:

"Indiana has significantly higher rates of AWD [abdominal wall defects] compared with national rates. Increased atrazine levels correlate with increased incidence of AWD."

Diagnosis

Before birth, openings in the abdomen can usually be detected by a detailed ultrasound or AFP screening. In addition to the ultrasound or AFP scanning, it is also necessary for children with this defect to be checked for other birth defects because genetic disorders are usually associated with some of the abdominal wall defects. In looking for other genetic disorders that may be associated, Genetic counseling and further genetic testing, such as amniocentesis, are offered. [1] [5] [6]

Treatment

Abdominal wall defects can be treated surgically if there are no accompanying anomalies. The surgical procedure also called omphalocele repair/closure or gastroschisis repair/closure is not overcomplicated. The organs are normal but are misplaced.[ citation needed ]

However, if the abdominal cavity is too small or when the organs are too large or swollen to close the skin, it may be difficult to fit all the viscera into the small abdominal cavity. In such cases, the surgeon will place a covering pouch generally made of silastic, commonly called a silo (because it's shaped like an agricultural silo), over the abdominal organs on the outside of the infant. [7] The silo serves to conserve heat and prevent infection. [7] The silo is spring-loaded so that the device can be attached to the inside of the abdominal wall without sutures. The top of the silo is secured in a way that causes it to stand upright, so that the bowels are gradually coaxed into the abdominal cavity by gravity. This process can take up to a week, and final closure may be performed a few weeks later. More surgery may be required to repair the abdominal muscles at a later time.[ citation needed ]

Prognosis

If there are no other defects, the prognosis after surgical repair of this condition is relatively good. However, 10% of those with more severe or additional abnormalities die from it. The organs themselves are fully functional; the difficulty lies in fitting them inside the abdomen. The condition is, in fact, a hernia requiring only replacement and strengthening of the passageway through which it occurred. After surgery, increased pressure in the stretched abdomen can compromise the function of the organs inside.[ citation needed ]

Incidence

Abdominal wall defects, specifically the main two types, gastroschisis and omphalocele, are rare, occurring in about one out of every 5000 births. [1] There is no difference in prevalence between boys and girls. Birthing individuals who are below the age of twenty are almost four times as likely to have an offspring that has developed an abdominal wall defect compared to those in their late twenties and older. [1]

See also

Related Research Articles

<span class="mw-page-title-main">Hernia</span> Abnormal exit of tissues or organs from the cavity they usually reside in

A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Various types of hernias can occur, most commonly involving the abdomen, and specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral. Other types of hernias include hiatus, incisional, and umbilical hernias. Symptoms are present in about 66% of people with groin hernias. This may include pain or discomfort in the lower abdomen, especially with coughing, exercise, or urinating or defecating. Often, it gets worse throughout the day and improves when lying down. A bulge may appear at the site of hernia, that becomes larger when bending down. Groin hernias occur more often on the right than left side. The main concern is bowel strangulation, where the blood supply to part of the bowel is blocked. This usually produces severe pain and tenderness in the area. Hiatus, or hiatal hernias often result in heartburn but may also cause chest pain or pain while eating.

<span class="mw-page-title-main">Prune belly syndrome</span> Medical condition

Prune belly syndrome is a rare, genetic birth defect affecting about 1 in 40,000 births. About 97% of those affected are male. Prune belly syndrome is a congenital disorder of the urinary system, characterized by a triad of symptoms. The syndrome is named for the mass of wrinkled skin that is often present on the abdomen of those with the disorder.

<span class="mw-page-title-main">Spina bifida</span> Birth defect of the spinal cord

Spina bifida /ˌspaɪnə ˈbɪfɪdə/ is a birth defect in which there is incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy. There are three main types: spina bifida occulta, meningocele and myelomeningocele. Meningocele and myelomeningocele may be grouped as spina bifida cystica. The most common location is the lower back, but in rare cases it may be in the middle back or neck.

<span class="mw-page-title-main">Iniencephaly</span> Rare neural tube defect characterised by fusion of the occiput with the spine

Iniencephaly is a rare type of cephalic disorder characterised by three common characteristics: a defect to the occipital bone, spina bifida of the cervical vertebrae and retroflexion of the head on the cervical spine. Stillbirth is the most common outcome, with a few rare examples of live birth, after which death invariably occurs within a short time.

<span class="mw-page-title-main">Patau syndrome</span> Chromosomal disorder in which there are three copies of chromosome 13

Patau syndrome is a syndrome caused by a chromosomal abnormality, in which some or all of the cells of the body contain extra genetic material from chromosome 13. The extra genetic material disrupts normal development, causing multiple and complex organ defects.

Cloacal exstrophy (EC) is a severe birth defect wherein much of the abdominal organs are exposed. It often causes the splitting of the bladder, genitalia, and the anus. It is sometimes called OEIS complex.

<span class="mw-page-title-main">Choanal atresia</span> Congenital disorder where the nasal passage is blocked

Choanal atresia is a congenital disorder where the back of the nasal passage (choana) is blocked, usually by abnormal bony or soft tissue (membranous) due to failed hole development of the nasal fossae during prenatal development. It causes persistent rhinorrhea, and with bilateral choanal atresia and obstructed airway that can cause cyanosis and hypoxia.

<span class="mw-page-title-main">Beckwith–Wiedemann syndrome</span> Genetic overgrowth disorder

Beckwith–Wiedemann syndrome is an overgrowth disorder usually present at birth, characterized by an increased risk of childhood cancer and certain congenital features. A minority (<15%) of cases of BWS are familial, meaning that a close relative may also have BWS, and parents of an affected child may be at increased risk of having other children with BWS. While children with BWS are at increased risk of childhood cancer, most children with BWS do not develop cancer and the vast majority of children who do develop cancer can be treated successfully.

<span class="mw-page-title-main">Omphalocele</span> Rare abdominal wall defect in which internal organs remain outside of the abdomen in a sac

Omphalocele or omphalocoele also called exomphalos, is a rare abdominal wall defect. Beginning at the 6th week of development, rapid elongation of the gut and increased liver size reduces intra abdominal space, which pushes intestinal loops out of the abdominal cavity. Around 10th week, the intestine returns to the abdominal cavity and the process is completed by the 12th week. Persistence of intestine or the presence of other abdominal viscera in the umbilical cord results in an omphalocele.

<span class="mw-page-title-main">Gastroschisis</span> Defect resulting in visible intestines

Gastroschisis is a birth defect in which the baby's intestines extend outside of the abdomen through a hole next to the belly button. The size of the hole is variable, and other organs including the stomach and liver may also occur outside the baby's body. Complications may include feeding problems, prematurity, intestinal atresia, and intrauterine growth restriction.

<span class="mw-page-title-main">Pediatric surgery</span> Medical subspecialty of surgery performed by pediatrics

Pediatric surgery is a subspecialty of surgery involving the surgery of fetuses, infants, children, adolescents, and young adults.

<span class="mw-page-title-main">Bladder exstrophy</span> Medical condition

Bladder exstrophy is a congenital anomaly that exists along the spectrum of the exstrophy-epispadias complex, and most notably involves protrusion of the urinary bladder through a defect in the abdominal wall. Its presentation is variable, often including abnormalities of the bony pelvis, pelvic floor, and genitalia. The underlying embryologic mechanism leading to bladder exstrophy is unknown, though it is thought to be in part due to failed reinforcement of the cloacal membrane by underlying mesoderm. Exstrophy means the inversion of a hollow organ.

<span class="mw-page-title-main">Congenital diaphragmatic hernia</span> Medical condition

Congenital diaphragmatic hernia (CDH) is a birth defect of the diaphragm. The most common type of CDH is a Bochdalek hernia; other types include Morgagni hernia, diaphragm eventration and central tendon defects of the diaphragm. Malformation of the diaphragm allows the abdominal organs to push into the chest cavity, hindering proper lung formation.

<span class="mw-page-title-main">Umbilical hernia</span> Medical condition

An umbilical hernia is a health condition where the abdominal wall behind the navel is damaged. It may cause the navel to bulge outwards—the bulge consisting of abdominal fat from the greater omentum or occasionally parts of the small intestine. The bulge can often be pressed back through the hole in the abdominal wall, and may "pop out" when coughing or otherwise acting to increase intra-abdominal pressure. Treatment is surgical, and surgery may be performed for cosmetic as well as health-related reasons.

<span class="mw-page-title-main">Epigastric hernia</span> Medical condition

An epigastric hernia is a type of hernia that causes fat to push through a weakened area in the walls of the abdomen. It may develop in the epigastrium. Epigastric hernias are more common in adults and usually appear above the umbilical region of the abdomen. It is a common condition that is usually asymptomatic although sometimes their unusual clinical presentation can present a diagnostic dilemma for the clinician. Unlike the benign diastasis recti, epigastric hernia may trap fat and other tissues inside the opening of the hernia, causing pain and tissue damage. It is usually present at birth and may appear and disappear only when the patient is doing an activity that creates abdominal pressure, pushing to have bowel movements, or crying.

<span class="mw-page-title-main">Triploid syndrome</span> Chromosomal disorder in which there are three copies of every chromosome

Triploid syndrome, also called triploidy, is a chromosomal disorder in which a fetus has three copies of every chromosome instead of the normal two. If this occurs in only some cells, it is called mosaic triploidy and is less severe.

<span class="mw-page-title-main">Bochdalek hernia</span> Medical condition

Bochdalek hernia is one of two forms of a congenital diaphragmatic hernia, the other form being Morgagni hernia. A Bochdalek hernia is a congenital abnormality in which an opening exists in the infant's diaphragm, allowing normally intra-abdominal organs to enter into the thoracic cavity. In the majority of people, the affected lung will be deformed, and the resulting lung compression can be life-threatening. Bochdalek hernias occur more commonly on the posterior left side.

The Fetal Treatment Center at the University of California, San Francisco is a multidisciplinary care center dedicated to the diagnosis, treatment, and long-term follow-up of fetal birth defects. It combines the talents of specialists in pediatric surgery, genetics, obstetrics/perinatology, radiology, nursing, and neonatal medicine.

<span class="mw-page-title-main">Lutembacher's syndrome</span> Medical condition

Lutembacher's syndrome is a very rare form of congenital heart disease that affects one of the chambers of the heart as well as a valve. It is commonly known as both congenital atrial septal defect (ASD) and acquired mitral stenosis (MS). Congenital atrial septal defect refers to a hole being in the septum or wall that separates the two atria; this condition is usually seen in fetuses and infants. Mitral stenosis refers to mitral valve leaflets sticking to each other making the opening for blood to pass from the atrium to the ventricles very small. With the valve being so small, blood has difficulty passing from the left atrium into the left ventricle. Septal defects that may occur with Lutembacher's syndrome include: Ostium primum atrial septal defect or ostium secundum which is more prevalent.

<span class="mw-page-title-main">Vaginal anomalies</span> Congenital defect; abnormal or absent vagina

Vaginal anomalies are abnormal structures that are formed during the prenatal development of the female reproductive system and are rare congenital defects that result in an abnormal or absent vagina.

References

  1. 1 2 3 4 5 6 7 8 "Abdominal Wall Defects". Encyclopedia of Children's Health. Retrieved November 28, 2012.
  2. "Abdominal wall defect: MedlinePlus Genetics". medlineplus.gov. Retrieved 2022-05-26.
  3. "Abdominal Wall Defects". Genetics Home Reference. Retrieved November 28, 2012.
  4. Mattix, KD; Winchester, PD; Scherer, LR (June 2007). "Incidence of abdominal wall defects is related to surface water atrazine and nitrate levels". Journal of Pediatric Surgery. 42 (6): 947–9. doi:10.1016/j.jpedsurg.2007.01.027. PMID   17560200.
  5. Agarwal, R (2005). "Prenatal diagnosis of anterior abdominal wall defects: Pictorial essay". Indian J Radiol Imaging. 15 (3): 361–372. doi:10.4103/0971-3026.29157.
  6. Kamata, S; Ishikawa, S; Usui, N; Kitayama, Y; Sawai, T; Okuyama, H; Fukui, Y; Kubota, A; Imura, K; Okada, A (February 1996). "Prenatal diagnosis of abdominal wall defects and their prognosis". Journal of Pediatric Surgery. 31 (2): 267–71. doi:10.1016/s0022-3468(96)90012-3. PMID   8938356.
  7. 1 2 Abdominal Wall Defects by Sajani Shah MD, at M&M Conference at SUNY Downstate Medical Center. Feb 24, 2006.