Abdominal Wall Defect : A 12 – Year Experience

Abstract

During the period 1986-1 997, 457 infants with abdominal wall defects were treated at the Queen Sirikit National Institute of Child Health. Their clinical data were reviewed. Omphalocele was diagnosed in 115 patients and gastroschisis in 342 neonates. Gastroschisis occurred in thrice as often as omphalocele and was increasing in frequency in recent years. The 71 percent incidence of prematurity in association with gastroschisis was significantly greater than the 51 percent incidence in omphalocele. The greatest hazard in gastroschisis was from small defects because of pressure necrosis and bowel perforation whereas in omphalocele, the greatest hazard was associated with large defects and severe anomalies. In omphalocele, non-intestinal viscus protruding through large defects was limited to the liver. In gastroschisis, the stomach, urinary bladder, uterus and adnexa eviscerated out of the large defects. Omphalocele was frequently associated with specific upper and lower midline anomalies, Beckwith - Wiedemann and trisomy syndromes (26.1%). These syndromes were not encountered in association with gastroschisis. Intracardiac malformations were more frequent in omphalocele (31.3%) than in gastroschisis (2.3%), and they were more complex and serious. Intestinal atresias were recorded in 15 neonates with gastroschisis but was not found in omphalocele. In contrast, 15 cases of imperforate anus occurred in omphalocele while they were not present in gastroschisis. Fourteen of the 15 patients were related to bladder or cloacal exstrophy and one case had imperforate anus only. Omphalocele and gastroschisis also differed with respect to gross appearances, clinical features and response to surgical therapy.