There are two main types of defect: gastroschisis (occurs less frequently) and umbilical hernia (more common). With both developmental defects, the intestinal loops (sometimes together with the liver and other organs) fall out through the abdominal wall outward, which requires surgical correction.
Care of the newborn
If the defect of the abdominal wall was detected before the birth of the child, at the time of its birth, a pediatric surgical team should be ready. If the defect is found after birth, the child should immediately be transferred to a specialized center. Gastroschisis is a prolapse of the intestine from the abdominal cavity through a hole located on the side of the umbilical cord (usually on the right). The diameter of the hole in the abdominal wall is, as a rule, 2-3 cm. A defect can appear at an early stage of intrauterine development and is most often the result of an "accident" in which the umbilical cord breaks through than with a congenital malformation. Usually, the small intestine and part of the colon fall out. More rarely, the liver, spleen and part of the stomach can fall out of the abdominal cavity. Perhaps the presence of a viscous liquid that adheres to the fallen intestine and significantly thickens it. Because of this, it can be difficult to detect concomitant atresia (infection) of the small intestine. Unlike the umbilical hernia, with gastroschisis around the defect of the abdominal wall there is no bag covering the organs, and the probability that the newborn suffers by any accompanying anomalies is lower.
Treatment
A child with gastroschisis quickly loses heat and fluid through falling organs. To prevent this, the organs must be wrapped in a film. The main goal is to maintain the life of the newborn during his transportation to the surgical department. In order to keep the intestines clean, a nasogastric tube can be inserted, and a glucose solution can also be introduced through the dropper. There are two main surgical methods of treatment. If possible, immediate surgical recovery is performed, but if this is not possible, the organs are placed in an artificial bag, which decreases in size for the next 7-10 days, pushing the organs back into the abdominal cavity. Then the surgeons sew up the skin in the place of the defect. Umbilical hernia is a congenital hernia of the umbilical cord, caused by a developmental malformation. The defect may be small or large and is often combined with chromosomal abnormalities. In this situation, surgical intervention is necessary. Umbilical hernia (also known as omphalocele) is the result of insufficient closure of the abdominal wall of the fetus during embryonic development, which results in the loss of internal organs through the opening in the umbilical cord. However, unlike gastroschisis, with umbilical hernia internal organs are surrounded by the peritoneum. Umbilical hernia is relatively rare - it is observed in about 1 in 5,000 newborns.
Perforation of the hernial sac
In most cases, the hernial sac at birth is not damaged. However, it can break out both before and during childbirth. Therefore, it is important that the doctor closely monitor the presence of the remains of a torn bag to avoid mistakes and not to confuse a hernia with gastroschisis (in which there is no bag covering the internal organs).
Large and small umbilical hernia
Umbilical hernia can be large or small. With a small umbilical hernia, the abdominal wall defect is less than 4 centimeters in diameter, there is no liver in the bag. The large hernia, on the contrary, is characterized by a hole diameter of more than 4 centimeters, with the liver and a different amount of intestinal loops inside the bag.
Concomitant anomalies
The disease is often accompanied by other birth defects, which include heart, kidney and colon malformations. In neonates with umbilical hernia, chromosomal abnormalities are also quite common (about 50% of cases). Especially important is the timely diagnosis of Beckwith-Wiedemann syndrome. Children with this syndrome develop an excessive amount of insulin-like growth factor during intrauterine development, which leads to severe hypoglycemia (low blood sugar level). This is especially dangerous, since it can cause irreversible brain damage; it is necessary to immediately start pouring in the glucose solution. When administering a patient with an umbilical hernia, it is important to note whether he has signs of Beckwith-Wiedemann syndrome, which include significant hypoglycemia caused by an increase in the pancreas. Virtually always umbilical hernias are detected in the early stages, and cases with concomitant developmental anomalies often result in miscarriages caused by intrauterine death or other causes. Postnatal newborn infants require infusion therapy, identification and confirmation of concomitant anomalies, and a blood test for glucose to exclude hypoglycemia. After this is done, the surgeon directly closes the defect. If immediate recovery fails, then it is carried out in stages using an artificial bag (as in gastroschisis).
Non-surgical treatment
Conservative treatment is indicated in patients with a complicated umbilical hernia who may not suffer surgical intervention. The bag is treated with a solution of antiseptic or alcohol in order to form a sterile scar. This gradually leads to covering the defect with the skin. In the future it is necessary to restore the muscles of the abdominal wall.