UNIVERSITY OF MEDICINE AND PHARMACY

EMERGENCY HOSPITAL OF CRAIOVA

DEPARTMENT OF PEDIATRIC SURGERY

Treatment evaluation in
congenital abdominal wall
defects
C. Sabetay, O Ciobanu, Anca Malos, E Carstoiu

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

ETIOPATHOGENY
Chromosomal anomalies
important factor
The cariotype

not a very

normal

The treatment of females sterility

occurrence of malformation ? (2
cases)
Mothers sanguine group (O, A2)
Increased incidence of omphalocele in
children with multipare mothers 66%

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Number of cases - 62

45 cases omphalocele

17 cases gastroschisis

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

OMPHALOCELE
AITKENS CLASSIFICATION

1st group
abdominal wall
flaw under
8cm

28 cases (62,3%)

2nd group
abdominal
wall flaw
over 8 cm

17 cases (37,7%)

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

DIFFERENTIAL
DIAGNOSIS

Umbilical hernia

Intracordonal omphalocele
(misinterpreted as umbilical
hernia)
Meckels diverticulitis
with Secondary peritonitis

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Extrophy of cloaca

Umbilical tumor

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

ASSOCIATED MALFORMATIONS
(17 cases)
Common mesentery 8 cases
Persistence of the omphaloenteric canal and Meckel
diverticle 4 cases
Urinary bladder extrophy 2 cases
Heart malformations 3 cases

Omphalocele
Left radius agenesia
Coronary hypospadias
Heart malformation

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

OMPHALOCELE - TREATMENT
25 cases, pure forms of omphalocele;
(Aitkens 1st group)
Surgical Gross method good results
20 cases
group

Aitkens 2nd

Schuster, Allen,
Wren, Fufezan

Grobs method (conservative treatment)

Coverage of the omphalocele bag with textile

materials imbued in mercurochrome solution 3%
Transformation into a big hernia

Secondary surgical treatment

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Aitkens
1st group

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Grosss method
Final result

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Aitkens
2nd group

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

(continued)

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Conservative
treatment

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Grobs method
intermediary
results (1)

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Grobs method
intermediary
results (2)

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Grobs method
intermediary
results (3)

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Grobs method
Final result

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Gastroschisis
-primary closure
-secondary closure
Gore-Tex
Silicon bag

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Silicon bag

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Day 5

Day 6

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Day 10

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Omphalocele
and

Gastroschisis

Embryology

Migration
defect

closure

Defect always situated

on the right side of the
umbilicus

Anatomy

Median defect,
with sac

always

Defect always situated

on the right side of the
umbilicus, no sac

Associated malformations

Yes +++

Rare +/-

Treatment/surgery

Not an emergency
Conservative treatment

Emergency, precocious
surgical treatment

Nutrition

Precocious

TPN

Long term prognosis

Bad, due to associated

malformations

Good

Department of Pediatric Surgery, Emergency Hospital Craiova, Prof. Dr. Corneliu SABETAY

Discussions survivor rate

-prenatal diagnosis
-Birth

presentation

time
-Associated malformations
-Rupture of the membranes (sac) in
case of omphalocele
-Size of defect (omphalocele)
-Immaturity
-Respiratory complications