Pediatric Omphalocele and Gastroschisis Workup

  • Author: James G Glasser, MD; Chief Editor: Ted Rosenkrantz, MD   more...
 
Updated: Dec 1, 2011
 

Laboratory Studies

Elevation of maternal serum alpha-fetoprotein (MSAFP) is associated with abdominal wall defects.

MSAFP levels are greater in gastroschisis than in omphalocele.

MSAFP levels are also increased in spina bifida, which additionally increases the ratio of acetylcholinesterase and pseudocholinesterase.[14]

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Imaging Studies

In utero ultrasonography may demonstrate a structural defect that is associated with a karyotypic abnormality.[25]

The suspicion that the baby has a genetic abnormality should be confirmed with amniocentesis.

Fetal echocardiography may identify a cardiac abnormality.

If serial ultrasonography shows dilatation and thickening of the intestine in a baby with gastroschisis, delivery should occur as soon as appropriate. Once amniocentesis demonstrates lung maturity, delivery should be expeditiously induced.

Postnatal evaluation to determine other congenital anomalies should occur prior to surgical intervention in those infants with omphalocele.

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Contributor Information and Disclosures
Author

James G Glasser, MD  Clinical Associate Professor, Department of Surgery and Pediatrics, Department of Pediatric Surgery, University of South Carolina Medical School; Consulting Staff, Palmetto Health Alliance Children's Hospital

James G Glasser, MD is a member of the following medical societies: American Pediatric Surgical Association, Christian Medical & Dental Society, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David N Sheftel  MD, Assistant Professor of Pediatrics, Chicago Medical School at Rosalind Franklin University of Medicine and Science

David N Sheftel is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP  Professor of Pediatrics (Neonatology), Vanderbilt University School of Medicine; Director, Neonatal Follow-up Program, Monroe Carell Jr Children's Hospital at Vanderbilt

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, National Hospice and Palliative Care Organization, Society for Pediatric Research, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Carol L Wagner, MD  Professor of Pediatrics, Medical University of South Carolina

Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD  Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

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Baby with an intact omphalocele.
Baby with an umbilical cord hernia.
Baby with gastroschisis.
Baby with a ruptured omphalocele.
Baby with gastroschisis and associated intestinal atresia.
Baby with gastroschisis and colon atresia. Bulbous proximal end of the atretic colon is excised, and a colostomy is created at the abdominal wall defect. An anastomosis of the proximal, dilated colon to the distal microcolon (in view of its small caliber) would not function properly. The colostomy can be closed 4-6 weeks later. (Gastrostomy tubes are no longer routinely used.)
Note the enlarged tongue in this baby with Beckwith-Wiedemann syndrome.
Baby with pentalogy of Cantrell.
Silo closure of a baby with gastroschisis.
Completed reduction of the bowel contained within the silo; the silo is about to be removed and the abdominal wall closed.
Case A. Baby with a giant omphalocele.
Case A. Closure of the giant omphalocele using a synthetic patch.
Case A. Tightening the abdominal wall closure
Case A. Flank flaps were used to close the giant omphalocele in the baby whose patch became infected.
Case A. The flank wounds were skin grafted and closure of the giant omphalocele obtained.
Baby with prune-belly syndrome.
Note the laxity of the abdominal wall in this baby with prune-belly syndrome.
Baby with cloacal exstrophy.
Note the bifid genitalia in this baby with cloacal exstrophy.
In the repair of cloacal exstrophy, the ileum in the middle of the bifid bladder is excised and used to create an ostomy, and the bladder halves are approximated.
Closure of the bladder exstrophy.
Baby with bladder exstrophy and epispadias; note the appearance of the bladder mucosa, indicating chronic inflammation.
Another view demonstrating the epispadias shown in the previous image.
Baby with isolated epispadias.
An operative photo from the repair of a draining umbilicus.
Closure of a giant omphalocele with an AlloDerm patch.
Two months after implantation: epithelialization of the AlloDerm patch.
Eight months after implantation: epithelization is nearly complete, but a huge ventral hernia has developed.
Persistent drainage from the umbilicus.
Baby with an omphalocele.
Complicated gastroschisis.
Following reduction of eviscerated viscera (and lysis of adhesions, tubularization of the viable, mesenteric portion of the proximal jejunum).
Recent radiograph showing the intestine following multiple "STEP" procedures.
 
 
 
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