Abdominal wall, umbilicus, omenteum

Sabiston

769-781

Abdominal wall

Musculoaponeurotic structure Attachments Defects: congenital, acquired,iatrogenic

Anterior abdominal wall

• Protect viscera

• Respiratory function

• Urination

• defecation

Anatomy 1. Skin 2. SubQ 3. Scarpa fascia 4. Ext. Abd. Oblique M 5. Int Abd. Oblique M 6. Transversus abd. 7. Transversalis fascia: hernia 8. Extraperitoneal fat 9. Parietal peritoneum

Lymphatics

Above umb: – ipsilateral axillary LN

Below umb: – ipsilateral superficial inguinal LN

Blood supply

Superior epigastric A – from int. thx. A

Inferior epigastric A – from ext. iliac A

Lower intercostal Iliac circumflex arteries

Congenital abnormalities

Diastasis recti: most common– Weakness of linea alba – No treatment

Omphalocele Gastroschisis

Case

Neonate with protrusion in the umbilicus

Exomphalos and gastroschisis

Two different congenital anomalies Differ markedly in their clinical appearance Overall incidence is approximately 1: 3000

live births Usually diagnosed prenatally on ultrasound

Exomphalos

Sac contains intestinal loops, liver, spleen and bladder

Often associated with other major congenital anomalies

Prognosis depends on theses associated anomalies

Mortality is approximately 40%

Exomphalos

Often associated with other major congenital anomalies

Prognosis depends on theses associated anomalies

Mortality is approximately 40%

Gastroschisis

A gastroschisis never has a sac Umbilical cord arises from normal place in

abdominal wall Usually to the left of the abdominal wall defect Evisceration usually only contains intestinal loops Rarely associated with major congenital anomalies

Exomphalos Rx

Treatment depends on the size of the lesion Aims of treatment are to reduce contents

into small abdominal cavity If bowel is covered there is no urgency to do

this

Gastroschisis

Infants have better prognosis than those with an omphalocele

Mortality is approximately 10%

Rx

usually direct full-layer closure of abdominal wall

May be associated with postoperative gut dysfunction

Usually require postoperative nutritional and ventilatory support

Granuloma: silver nitrate

Omphalomesenteric duct

Midgut-yolk sac Polyp: excision Sinus: sinogram, excision Persistent omphalomesenteric duct Cyst: volvulus Meckel’s diverticulum

Urachus

Umb/bladder May become infected Diverticula of bladder

Omentum

• Double endothelium

• Vessels

• Lymphatics

• Nerves

• Fat

Omentum

• Large in obese

• Can be removed

• Policeman of the abdomen

• Movement by intestine

• Can adhere firmly

Omentum

• Torsion

• Cysts

• Solid Tumors

• Vascular pedicle flap: neck/knee

-Wrap anastomosis, lymphedema, liver for hemostasis, biliary leak, chest wall reconstruction