Omphalocele and Gastroschisis
Background
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Both are defects of anterior abdominal wall that permit external herniation of abdominal viscera
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Omphalocele: contents are covered by a sac formed by the peritoneal membrane (up to 3/4 of omphalocele cases are associated with other congenital defects including cardiac anomalies & trisomy 21)
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Gastroschisis: hernia sac does not cover the herniated abdominal viscera. Therefore, the bowel is exposed to the external environment
Considerations
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Neonate considerations
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Sequelae of open abdomen:
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Aspiration
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Hypothermia
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Fluid & electrolyte abnormalities
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Sepsis
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Discussion with surgeon regarding primary versus staged closure
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Abdominal compartment syndrome after closure:
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Shock/cardiac dysfunction, ↓ venous return
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Acute kidney injury
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Restrictive lung disease/respiratory failure
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↓ splanchnic & liver blood flow (prolonged drug effect)
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Congenital heart disease considerations if present with omphalocele
Management
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Needs RSI or awake intubation
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Needs muscle relaxation for closure
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Arterial line likely needed
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Potential for fluid shifts + need for ongoing resuscitation
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Avoid hypovolemia, coagulopathy, acidosis, hypothermia
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Likely back to NICU intubated