Anterior Abdominal-Wall-Defects in Sugery.pptx

This presentation is concerned with congenital abnormalities of the anterior abdominal wall which are commonly seen in tropics.
Prepared by Nigerian Medical students under supervision from their teachers/trainers

1. ANTERIOR ABDOMINAL WALL DEFECTS UG21/MDMD/1044 UG21/MDMD/1046 UG21/MDMD/1049

2. Anterior abdominal wall The anterior abdominal wall is the front portion of the abdomen, encompassing several layers of skin, muscles, and fascia. It protects and contains the abdominal organs, and also plays a role in trunk movement, breathing, and posture.

3. The muscles of the anterior abdominal wall include the rectus abdominis, external oblique, internal oblique, and transversus abdominis.

4. AAW DEFECT These are defects which are due to failure of the closure of the anterior fold of the mesenchyme. They are mostly congenital. They include; Omphalocele , Gastrochisis , Prune belly syndrome, Umbilical hernia, Extrophy of the bladder.

5. OMPHALOCOELE Anterior abdominal wall defect at the base of the umbilical cord with herniation of the umbilical contents. There is a presence of gelatinous sac as a covering to the content.

6. Incidence O mphalocoele 1:5000 Common in males Common in children of elderly mothers. Low socioeconomic class mothers

7. Clinical Findings Presence of a gelatinous sac. Layers of the sac; Peritoneum, Wharton’s jelly and yolk sac(Amnion). Associated with other syndromes Beckwith- Wiedemann , Pentalogy of cantrell , caudal syndrome.

8. >50% have associated defects like club foot, cleft palate/lip, undescended testis and hydrocephalus. Location: Epigastric Central Hypogastric Cord attachment is on the sac

9. Omphalocele can be classified based on the diameter of the sac; Omphalocele major <5cm and minor >5cm. Omphalocele can rupturewhich is tearing of the sac and the contents are in contact to the exterior.

10. GASTROSCHISIS Defect of the anterior abdominal wall just lateral to the umbilicus mostly on the right side without a covering sac. It is an obvious eviceration of bowel, which can be edematous, dilated, dusky and some can be gangrenous.

11. Incidence 1 in3000 Commoner in children with teenage mothers(<25yrs) AFP is 10 times normal

12. Clinical Findings Opening is less than 4cm. Usually isolated and not associated to other syndromes. No incidence in prenatal diagnosis.

13. MANAGEMENT Fluid Management IV fluid administration. Heat management; place the baby in a radiant warmer ( incubator). Nutrition; Ensure the baby is pink, adaquate calories and aseptic.

14. Gastric Distention NG tube to decompress the stomach. Infection Control Ampicillin and Gentamicin Associated Defects treated to its expertise.

15. Surgical Management Skin Flaps Primary Closure Staged Closure Staged repair using silo pouch

16. Skin Flaps

17. UMBILICAL HERNIA Defect in linea alba, failure of the umbilical ring to close, subcutaneous tissue and skin covering the protruding bowel Frequent in premature infants

18. PRUNE BELLY SYNDROME Thin, flaccid abdominal wall Dilation of bladder, ureter and renal collecting system 1:30,000-50,000 95% are male

19. Prune belly syndrome is a congenital abnormal muscle wall defect in which the patients have all layers of abdominal wall but little or no muscle.

20. BLADDER EXTROPHY Rare defect that exist with protrusion of the bladder to the exterior. It is part of spectrum of abdomino -pelvic fusion abnormalities known as Epispadias-Extrophy complex. Associated with prolapsed vagina or rectum, epispadias , bifid clitoris or penis.

21. PENTALOGY OF CANTRELL Omphalocoele Anterior diaphragmatic hernia Sternal cleft Ectopia Cordis Intracardiac defect

22. BECKWITH-WIEDEMANN SYNDROME Macrosomia Macroglossia Organomegaly Abdominal wall defects Embryonal tumors