How is a ruptured pediatric omphalocele treated?

Updated: Nov 05, 2019
  • Author: James G Glasser, MD, MA, FACS; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Answer

When the omphalocele membrane is ruptured, the extruded viscera are placed in a silo, as with the case of gastroschisis. [28]

If a giant omphalocele is ruptured, it may be best to obtain closure utilizing biologic mesh (Alloderm or Surgisis) [39] sutured to the fascial margins of the defect. (See the image below.)

Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). This intraoperative image reveals a ruptured omphalocele in an infant.

Closure of giant omphaloceles containing the liver is always challenging. [40, 41, 42] See the following images.

Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). This infant has a giant omphalocele that was treated with topical agents for several weeks. The omphalocele sac will absorb, leaving granulation tissue that gradually epithelializes.
Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). The omphalocele sac was adherent to the protuberant liver in an infant. It was covered with Gore-Tex so that gradual reduction could be effected.
Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). The Gore-Tex sheet is imbricated, gradually reducing the liver into the abdominal cavity: The rectus muscles are pulled over the liver.
Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). Final skin closure of the giant omphalocele was delayed because the baby developed respiratory distress. Unfortunately, the patch became infected and was removed. Later, bipedicled flank flaps were used to close the giant omphalocele, but reduction was lost.
Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). Split-thickness skin grafts were applied to the flank wounds resulting from mobilization of the bipedicle flaps.

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