By Dr Anyanwu Paschal Consultant Paediatric Surgeon National Hospital Abuja Anterior abdominal wall defects What are they Common types of interest Causes Presentation PathoPhysiology ID: 1014775
Download Presentation The PPT/PDF document "Anterior Abdominal wall defects" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Anterior Abdominal wall defectsBy Dr Anyanwu PaschalConsultant Paediatric SurgeonNational Hospital, Abuja.
2. Anterior abdominal wall defectsWhat are they?Common types of interestCausesPresentationPathoPhysiologyInvestigationTreatment of.
3. What are anterior abdominal wall defectsThese are a group of conditions, congenital and acquired in which there is defective formation or loss of integrity of one or more layers of the anterior abdominal wall.Consequently these defects are either obvious/ present at birth or are noticed over time as the child grow’s.Some cause minimal physiologic derangement while many more result in severe physiologic derangements if untreated and usually would result in death of the child unattended to.Also are part of larger series of anomalies constituting some syndromes.
4. Types of anterior abdominal wall defectsCongenital group. These are those that occur in utero, consequently the children are born with them. They include the following,OmphaloceleGastroschisisPrune Belly syndromeBladder extrophyAcquired group. These result usually in the course of the child’s life, some times there is a precipitating cause. Examples inclue;Umbilical herniasVentral hernias
5. omphaloceleThese are congenital conditions in which there complete defect in the development of the entire layers of the anterior abdominal wall usually centered on the location of the umbilicus.Consequently the intra abdominal viscera to varying degrees are exposed through these defects usually covered by a thin transparent membrane which may or may not be intact.Usually results from problems with the migration of the lateral mesoderm during development of the anterior abdominal wall.The size of the defect varies and is usually dictates how much intra abdominal viscera herniates out. The concept of an omphalocele major or minor is based on a defect size greater or less than 5 cm.More important in the management of these newborn is whether the membrane is intact or ruptured.Most omphalocele are associated with other congenital anomalies especially cardiac as well as being associated with some syndromes. The pentalogy of Cantrell, the Beckwitt Weidman syndromes, Lower midline syndromes, etc.
6. omphalocele
7. Omphalocele continuedInfants with omphalocele are risk of;Hypothermia,Hypoglycaemia,Hypovolaemia,Other risk are infection, trauma, bowel obstruction, respiratory difficulties.Initial management of newborn with omphalocele is to correct and prevent the hypovolaemia, hypothermia and hypoglycaemia. Afterwards efforts to provide cover for the exposed viscera is the next course of treatment.Repairing the defect in omphalocele can be operative or nonoperative.The operation can be primary or staged/ delayedAlso the operation can be as an emergency or non emergency.
8. Omphalocele managed with a silo
9. omphaloceleThe prognosis of newborn with omphalocele is influenced by the following;Is the membrane intact or rupturedWhat’s the size of the defectAre there associated anomalies and how severe are these.It is always important to be able to distinguish and differentiate between omphaloceles and gastroschisis.
10. GastroschisisIn this group of anomalies, there is a full thickness defect of the anterior abdominal wall usually to the side of a normally sited umbilicus, most often to the right.The size of the defect is usually very narrow and as such the exposed viscera mostly consists of the hollow viscera as the solid organs usually cannot pass through the defect.The exposed viscera usually lack any membrane cover.Most gastroschisis result from a vascular accident occurring in utero such as intussusception, abnormal vascular involutions.Most gastroschisis are usually not associated with any other congenital anomalies or syndromes. When anomalies are present, they are usually restricted to the gastrointestinal system.Presentation is usually that of a newborn delivered with exposed viscera herniating through a narrow defect usually to the right of the umbilicus.
11. Gastroschisis
12. GastroschisisThese newborn also are at risk from;Hypovolaemia Hypo thermia HypogycaemiaInfection.Initial management involves measures aimed at correcting and preventing the conditions.When the newborn has been resuscitated, the definitive treatment involves emergency surgery/operation. This could be primary repair or use of extraabdominal silos to encourage expansion of the intraabdominal compartment and then fascial closure or repair later.There is no room for non operative management.The outcome for patients with gastro schisis is usually very good to excellent.
13. Differences between omphalocele and gastroschisisOmphaloceleCentral defectAssociated with other congenital anomaliesMaybe syndromicDefect can be very largeCan be managed non operativelyDefect may be covered by a membraneGastroschisisTo the side of the midlineNot usually associated with other congenital anomaliesNot usually part of a syndromeDefect is usually narrowTreatment is only operativeDefect lacks any covering membrane
14. omphalocelegastroschisis
15. Prune belly syndromeAlso known as the triad syndrome, or the eagle barrett syndrome. It characterized by abnormal formation and development of the mesodermal layer of the anterior abdominal wall, usually in it’s lower half.It is also associated with bilateral undescended testes as dilatation of the upper urinary tract.Usually such affected infants are born with a severely wrinkled looking anterior abdominal wall.These children are at risk of recurrent urinary and respiratory tract infections as well as failure to thrive or independently ambulate early.There management involves initial non operative treatment and later series of surgeries to fix the testes and repair the anterior abdominal wall and upper urinary tract if indicated.
16. Prune Belly syndrome
17. Bladder extrophyIn this anomaly, there is failure of development of the entire layer of the lower, midline anterior abdominal wall as well as the anterior bladder wall and pubic symphysis.Maybe associated with an omphalocele in most cases.Usually there is associated epispadias of the penis.Major risk to the child is recurrent urinary tract infection.Children also develop a waddling gait when the start walkingTreatment involves multiple staged surgeries to repair the bladder, anterior abdominal wall, penis and the bladder neck as well as the pelvic ring.
18. Bladder extrophy
19. Acquired anterior abdominal wall defectsUmbilical hernia.One of the commonest types of hernia found in children especially those of negroid descent.Usually noticed from the second week of life.Most of them result from infection at the umbilical stump or from weak umbilical scar due to abnormal collagen.85 % of umbilical hernia will resolve spontaneously by 5 to 8 years of age.Surgery is only indicated in;Very large hernias,Those with obstructive symptomsFor cosmetic reasons.
20.
21. Ventral herniasAside the umbilical hernia, these include the epigastric hernias, incisional hernias, paraumbilical hernias.
22. Ventral hernia.
23. Neonatal intestinal obstruction By Dr Anyanwu PaschalConsultant Paediatric Surgeon,National Hospital, Abuja.
24. Neonatal intestinal obstructionWhat’s intestinal in the newborn.What are the common causesHow do they presentConsequence of unrelieved intestinal obstruction in the new bornInvestigationTreatment of newborn intestinal obstruction
25. Neonatal intestinal obstructionNeonatal intestinal obstruction is intestinal obstruction occurring the newborn kids between the age of 1 to 28 days of life.Intestinal obstruction implies a impediment to the normal flow of intestinal luminal content toward the anus.Intestinal obstruction in the newborn is rather different from all the other age groups because most of the causes of intestinal obstruction in the newborn are congenital rather than acquired causes which is the more usual cause in older age groups.Also some of the causes of intestinal obstruction in the newborn can be diagnosed before birth during routine antenatal ultrasound screen so as to enable planned delivery of such children in facilities with paediatric surgical services.
26. Causes Broadly the causes of intestinal obstruction in the newborn are either in the small intestine also known as upper intestinal obstruction, or in the large intestine also known as lower intestinal obstruction.Additionally, the causes of the intestinal obstruction maybe mechanical or functional.Cause of upper intestinal obstruction include;Malrotation syndrome.Duodenal atresiaJejunoileal atresiaInternal herniasCongenital bands
27. Causes Causes of lower intestinal obstruction include the following;Hirschsprung’s diseaseAnorectal malformationColonic atresiaSmall left colon syndromeMeconium plug syndromeIntestinal neuronal dysplasia
28. Presentation Antenatal polyhydraminousBile stained vomitingAbdominal distensionFailure to pass meconiumDehydrationReduced urinary outputWeakness and reduced activityshock
29. Consequence of unresolved intestinal obstructionContinued fluid and electrolyte loss from vomiting and distensionFail in the blood supply to the involved bowelBacterial overgrowth and translocation across the compromised bowelSepticaemia Hypovolaemic shockSeptic shockMultiple organ dysfunction.
30. Investigation of neonatal intestinal obstructionPlain xray in erect and supine views.Erect view showing multiple air fluid levels.May show the double bubble sign of duodenal obstructionSupine view showing the dilated/ distended bowel loopsMay also reveal absence of air in the distal colon.Abdominal ultrasound scan, especially with doppler may help to diagnose mid gut volvulus and malrotation syndrome.Contrast xrays, like barium/gastrografin enema
31. Double bubble sign in duodenal atresia/ obstructions
32.
33. Dilated bowel loops
34. Barium enema showing transition zone.
35. Treatment Treatment of neonatal intestinal obstruction involves initial resuscitation of the child before definitive treatment dictated by the identified cause of the obstruction.Resuscitation involves;Correcting all fluid and electrolyte derangementsNasogastric tube to decompress a dilated stomachUrethral catheterization to monitor adequacy of the fluid resuscitationAntibiotics to control sepsis.
36. Definitive treatmentDefinitive treatment is usually dictated by the identified pathology.Most cases would require surgery to address the offending pathology.1, malrotation syndrome;Exploratory laparotomy,Release of any volvulus ( detorsion)Release of Ladd’s bandsAppendectomyWiden the mesenteric base.The above is also know as the Ladd’s procedure.
37. Definitive treatmentDuodenal atresia;Exploratory laparotomyDuodenoduodenostomyExcision of duodenal membrane/webJejuno-ileal atresia;Exploratory laparotomyResection of atretic portion and re-establish bowel continuity.
38. Proximal jejunal Atresia
39.
40. Definitve treatmentHirschsprung’s disease;Initially non operative using bowel washout.May require a colostomy to aid bowel decompressionA pull through surgery by the Swenson, Soave or the Duhamel technique.Anorectal malformation;Anoplasty in the newborn period for very low anomaliesColostomy in the newborn period for all other formsPosterior sagittal anorectoplasty” PSARP” at 6 months to 1 year of age
41. Divided colostomy for anorectal malformation
42. THANK YOU