Children

Embryonic hernia, omphalocele, or - is a congenital anomaly in which the contents of the abdominal cavity protrudes through the umbilical cord into the ring.

Gastroschisis means "splitting of the stomach." It is a congenital defect of the abdominal wall, usually to the right of the umbilical cord. The contents of the abdominal cavity protrudes into the amniotic sac, usually only the small intestine, but may be the stomach, rectum and ovaries. Unlike embryonic hernia offline coating membrane.

Omphalocele and gastroschisis - the most common malformations encountered by pediatric surgery.

The incidence of fetal hernia increased slightly in recent years and is approximately 1-2, 5 cases per 5000 births. Epidemiological studies have shown an association with increasing maternal age and the influence of genetic factors, which became evident after studying twins and evidence, that the defect is often found in the same family.

One study showed that 50% of children diagnosed with an umbilical hernia as the only apparent departure, after careful study identified other genetic defects. The authors recommend looking for these defects in all children with fetal hernia.

On the other hand, the incidence of gastroschisis has increased markedly over the past 25 years and is now at 4-5 cases per 10,000 births. The increase in the spread is described as a pandemic and is of interest as a possible confirmation of the interaction between genes and the environment.

Embryonic hernia and gastroschisis are related to factors that cause failure of the placenta, including the mother's illness, infection, drug addiction and smoking. One study also showed that ibuprofen early in pregnancy is a moderate risk factor for gastroschisis. Alcohol - moderate risk factor for gastroschisis in early pregnancy and fetal hernia - in the first trimester.

Manifestations of umbilical hernia

Embryonic hernia and gastroschisis may be determined to improve the AFP in the second trimester or deviations found during ultrasound.

Embryonic hernia is a defect of the abdominal wall the size of 4-12 cm, which can be central, epigastric and hypogastric. Major defects may be associated with hypoplasia of the abdominal cavity and chest. One study showed that 74% patients with 4 omphalocele have other defects, unlike patients with gastroschisis, where such a total of 16, 6%.

Gastroschisis is usually seen as a hole less than 5 cm in length, the right side of the umbilical cord. Variations in size, are smaller than in the case of fetal hernia. And other abnormalities are not usually observed.

Differential diagnosis

Omphalocele and gastroschisis should be distinguished from each other and from other cases of tumors of the abdominal wall. Omphalocele located closer to the center than gastroschisis, coated with a membrane and frequently occurs in conjunction with other defects. Hernial sac in these two cases are different. When fetal hernia is harder and may include liver and intestine tightly compressed, and with gastroschisis bag contains only loose bowel loops and softer.

Other cases of tumors of the abdominal wall include:

• Physiological protrusion of the intestine. It appears on the tenth - thirteenth week of pregnancy and can be detected by ultrasound. It can be distinguished from embryonic herniation Hernia: Types and symptoms - which are the most dangerous?   because at the fifteenth week it disappears. Major defects, including the liver, indicating fetal hernia at any stage.
• Umbilical hernia. It often occurs in premature infants. Put this diagnosis helps ultrasound examination.
• Amniotic band constriction. This is a common cause of anomalies of the abdominal wall. Constrictions occur due to random internal rupture of the amniotic membrane, which leads to the formation of fibrous filaments sac. The manifestations may be similar to gastroschisis, but scan may show an atypical position of the defect and contiguity to the amniotic membrane.
• Bladder exstrophy. On the ultrasound image (girls) looks like a tumor on the genitals. Sequential scanning does not show the presence of the bladder can be detected and other defects of the urogenital system.
• Complex limb, abdominal wall. It is a hard and fatal anomaly in the abdominal wall side of the umbilical cord. It may also be found other defects - the heart, limbs, brain and spinal cord.
• Multiple cavernous hemangioma Hemangioma - than it is dangerous? . They are usually found at the bottom of the trunk. It can be detected by other superficial tumors which cause hypertrophy extremities. This deviation is called a syndrome Klippel-Trenonneya.
• Pseudo-omphalocele. This term is used to describe structurally normal abdominal cavity, which has changed shape due to external pressure. This can happen, for example, due to the pressure of the ultrasonic sensor. It may also occur due to low water and other causes compression of the bottom wall of the thoracic cavity.

Studies at the recommended umbilical hernia

• The level of alpha-fetoprotein in the serum of the mother. It increases with omphalocele and gastroschisis, and at the last level of above.
• Karyotyping. There is a strong link between fetal chromosomal abnormalities and a hernia, so karyotyping is recommended as an important part of the survey.
• Ultrasound examination. This is the basis of diagnosis. You can differentiate a hernia from fetal gastroschisis and other cases of tumors of the abdominal wall, judging by the size and position of the defect-related features.
• Magnetic resonance imaging. It may be useful, in addition to ultrasound, especially to determine the position of the anomaly on the liver.
• Other ways. Babies with fetal hernia may be used an ultrasound of the kidneys, an echocardiogram and a simple X-ray of the sacrum to exclude associated anomalies.

Treatments

Amniocentesis is shown if there is an increased level of alpha protein and suspected fetal ultrasound examination after hernia.

Related diseases

Omphalocele may be associated with a number of congenital defects, such as:

• Pentalog Cantrell. This deviation accompany omphalocele split sternum, anterior diaphragm hernia, heart defects and the lack of the pericardium.
• Beckwith-Wiedemann syndrome. It is an innate state of hypertrophy, accompanied omphalocele, macroglossia and gigantism.
• Genetic disorders. Trisomy 13, 18 and 21 can be combined with fetal hernia, confirming the theory that some cases have a genetic defect that causes.
• Cloacal exstrophy. This low situated omphalocele in conjunction with cloacal exstrophy or bladder exstrophy. It may also be combined with other defects of the lower body, for example, meningomyelocele, anal atresia or lower limb defects.
• Also available malocclusion and musculoskeletal defects.

Gastroschisis.   In this case, the associated defect less than when omphalocele, but they occur in 7-30% of children. It can be such anomalies as anantsefaliya, cleft lip and palate, ectopic heart, atrial septal defect, the hernia of the diaphragm, scoliosis, syndactyly and amniotic constriction. The intestinal atresia, malabsorption, atypical appendicitis, volvulus of the midgut, GORD Reflux: the failure of the esophagus   Hirschsprung's disease and may also occur. Noting also communicate with polyhydramnios, so if it is seen with ultrasound, increases the probability of diagnosis.

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