Subject : omphalocele writer : fateme rezaei Assistant
professor :Dr.moein In the name of God
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omfalocele An omphalocele is a birth defect in which the
infant's intestine or other abdominal organs stick out of the belly
button (navel). In babies with an omphalocele, the intestines are
covered only by a thin layer of tissue and can be easily seen. An
omphalocele is a type of hernia. Hernia means "rupture.
Slide 3
Causes, incidence, and risk factors An omphalocele develops as
a baby grows inside the mother's womb. The muscles in the abdominal
wall (umbilical ring) do not close properly. As a result, the
intestine remains outside the umbilical cord. Approximately 25 -
40% of infants with an omphalocele have other birth defects. They
may include genetic problems (chromosomal abnormalities),
congenital diaphragmatic hernia, and heart defects.
Slide 4
Symptoms An omphalocele can be clearly seen, because the
abdominal contents stick out (protrude) through the belly button
area. There are different sizes of omphaloceles. In small ones,
only the intestines stick out. In larger ones, the liver or spleen
may stick out of the body as well.
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Signs and tests Prenatal ultrasounds often identify infants
with an omphalocele before birth. Otherwise, a physical examination
of the infant is enough for your health care provider to diagnose
this condition. Testing is usually not necessary
Slide 6
Treatment Omphaloceles are repaired with surgery, although not
always immediately. A sac protects the abdominal contents and
allows time for other more serious problems (such as heart defects)
to be dealt with first, if necessary. To fix an omphalocele, the
sac is covered with a special man-made material, which is then
stitched in place. Slowly, over time, the abdominal contents are
pushed into the abdomen. When the omphalocele can comfortably fit
within the abdominal cavity, the man-made material is removed and
the abdomen is closed. Sometimes the omphalocele is so large that
it cannot be placed back inside the infant's abdomen. The skin
around the omphalocele grows and eventually covers the omphalocele.
The abdominal muscles and skin can be repaired when the child is
older to achieve a better cosmetic outcome.
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Expectations (prognosis) Complete recovery is expected after
surgery for an omphalocele. However, omphaloceles often occur with
other birth defects. How well a child does depends on which other
conditions the child also has. If the omphalocele is identified
before birth, the mother should be closely monitored to make sure
the unborn baby remains healthy. Plans should be made for careful
delivery and immediate management of the problem after birth. The
baby should be delivered in a medical center that is skilled at
repairing omphaloceles. The baby's outcome is improved if he or she
does not need to be taken to another center for further treatment.
Parents should consider screening their unborn baby for other
genetic problems that are associated with this condition.
Slide 8
Complications Death of the intestinal tissue Intestinal
infection
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Calling your health care provider This problem is diagnosed and
repaired in the hospital at birth. After returning home, call your
health care provider if the infant develops any of these symptoms:
Decreased bowel movements Feeding problems Fever Green or yellowish
green vomit Swollen belly area Vomiting (different than normal baby
spit-up) Worrisome behavioral changes
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All About Zack's Omphalocele Zack was born with a giant
omphalocele (containing at least some of his liver and bowel).
Fortunately he had no other defects and no other problems. He was
in the ICU for only two days, and we were able to take him home a
week after birth. He was first breast-fed when just two days old,
and he's been eating solid food since he was five months old.
Slide 16
Two hours after he was born, he went to Children's Hospital and
Regional Medical Center in Seattle. Many babies with giant
omphaloceles have surgery right after birth, but Children's
Hospital's approach ("Paint and Wait") is more conservative. "Paint
and Wait": Twice a day, we covered the omphalocele with Silvadine,
a bacteriostatic burn cream which toughens and protects the sac. We
then wrapped it in gauze and foam supports. An Ace bandage was
wrapped around his abdomen to push the omphalocele's contents back
in where they belonged.
Slide 17
When Zack was 7.5 months old, our pediatric surgeon decided
that Zack's abdomen was large enough to surgically pull the muscles
together. This was successfully done on 23 September 2002, and Zack
even got a belly button! We're thrilled! A picture of his new tummy
has been posted at the bottom of this page. We are happy to talk
with anyone expecting an "O" baby about the "paint and wait"
procedure. One woman's surgeon agreed to try paint and wait after
seeing Zack's results, and she and the surgeon were thrilled with
the child's outcome
Slide 18
Zack's omphalocele at birth. The sac is very fragile. The spot
that looks a bit different is probably exposed bowel wall. (The
tube in his mouth sucked air out of his stomach to prevent any
pressure on fragile sac. It was removed after a day.)
Slide 19
Zack was just a few days old here. The sac has toughened and
become opaque with Silvadine applications.
Slide 20
One week old and home from the hospital! The lump on his tummy
is the omphalocele and many layers of foam and bandaging protecting
it.
Slide 21
You can see why there's such a big bump under his clothes. Here
is the foam cap that protects his omphalocele so we are free to
cuddle with him.
Slide 22
Underneath that foam cap are many layers of bandages. The blue
foam supports the sides of the omphalocele so that it doesn't flop
over.
Slide 23
One month old. He likes to have his back massaged when the
bandaging is removed.
Slide 24
Two months old. You can see how "tall" the omphalocele is. Also
notice the skin beginning to grow up the side of the
omphalocele.
Slide 25
Another two month old picture. You can see all of the different
parts of Zack's dressing. The omphalocele started to flop over
Zack's chest. An Occupational Therapist at Childern's Hospital
solved this by making a support out of a blue foam strip, a foam
wedge, and another blue foam strip.
Slide 26
A foam cap is placed on top. This was smaller than the ones
used previously because the omphalocele is actually shrinking. We
then wrapped an Ace bandage around everything to provide gentle
pressure to encourge everything to go inside of his abdomen
Slide 27
Three months old. You can see that there is skin over half of
the omphalocele. (Since the omphalocele's sac was intact, we could
give him baths. We were careful not to submerge the
omphalocele.
Slide 28
When Zack was four months old, we were able to "wrap him flat"!
He looked completely normal when wearing clothes. Over the past
month, we were more aggressive with wrapping him. We cut down the
blue foam strips and then removed them as the omphalocele got
smaller
Slide 29
Another photo at four months. This is the unwrapped
omphalocele. (The measurement is centimeters.) The pink on the uper
left is skin. You can see the skin growing up the bottom of the
omphalocele. The white part on the right is the gauze used to tie
off the umbilical cord.
Slide 30
Another view of the omphalocele at four months. On the left is
the new pink skin
Slide 31
Zack at five months old. The omphalocele is tiny! Everything is
inside his abdomen. Skin is still growing over his omphalocele, and
once a day we put Silvadine on the part without skin. We put two
types of gauze bandaging on top of the omphalocele and then wrap an
Ace bandage around his middle
Slide 32
These two pictures were taken three days before Zack's surgery
when he was 7.5 months old. The omphalocele hasn't changed much
since the last photo. You can see that it is higher than a normal
belly button. The dark spot in the center is part of the sac that
skin still has not grown over. You can also see the gap in his
abdominal muscles. The gap makes a teardrop shape
Slide 33
Zack is 10 months old in this photo. When he was 7.5 months
old, his surgeon at Seattle Children's Hospital performed the
closure surgery and Zack spent 4 days recovering. He has been right
on track for all of the regular baby milestones (crawling, walking,
etc.). The long incision line is the omphalocele closure. Lower on
his abdomen Zack's surgeon created a fake belly button by cutting a
flap out and rolling it into an open tube (it looks like a "C").
Zack spent 7 days in the hospital at birth, 4 days after his
surgery at 7.5 months, and went to a dozen or so clinic visits, but
now he's done.
Slide 34
We have come a long way since the inital omphalocele diagnosis
when Mandy was 15 weeks pregnant. We very badly wanted our baby to
be healthy and whole, and we worried about what would happen when
he was born. Our worries have evaporated, and we have been very
happy with Zack's treatment. We are incredibly grateful to the
professionals at Children's Hospital not only for their devoted
service but for their compassion. And we thank God for being with
us every step of the way. We have been blessed by the prayers of
family and friends and even the prayers of people that we don't
know. Zack's full name is "Zachariah", which means "God has
remembered". We know that He always remembers our precious little
boy
Slide 35
.References Turnage RH, Richardson KA, Li BD, McDonald JC.
Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and
retroperitoneum.In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox
KL, eds. Sabiston Textbook of Surgery. 18th ed.Philadelphia, Pa:
Saunders Elsevier; 2007:chap 43. Ledbetter DJ. Gastroschisis and
omphalocele. Surg Clin North Am. 2006;86(2):249-260 Pubmed Medscape
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