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KMID : 0381219740060080396
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Journal of RIMSK
1974 Volume.6 No. 8 p.396 ~ p.405
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Defect of Umbilicus and Anterior Abdominal Wall Omphalocele and Gastroschisis
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Abstract
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The embryological basis for the somatic anomalies of the umbilical region and anterior abdominal wall can be summarized to following stages: 1) in the third week of fetal life when ventral closure of the body of the embryo is accomplished; 2) in the tenth week of fetal life when intestines return to the peritoneal cavity; and 3) after birth when the umbilical ring becomes obliterated by a proliferation of fibrous tissue.
Omphalocele may result from defective ventral closure of the embryo or persistence of the extracoelomic position of the intestines in fetal life. It is frequently associated with other malformations threatening survival of the infant. The herniated abdominal viscera are covered by a translucent amniotic membrane into which the umbilical cord inserts. This sac is greatly susceptible to rupture. The over all mortality rate approximates 50%. Operative treatmeant can be accomplished in one or two stages. Conservative treatment is possible in selected cases. Schuster method using synthetic mesh as temporary coverage cast better prognosis for this grave disease. Intravenous hyperalimentation also serves for better survival.
Gastroschisis occurs as a result of deficient ventral closure of the body of the embryo. Viscera herniate through a full thickness paraumbilical defect into the amniotic fluid which surrounds the fetus. No hernial covering sac is present and the insertion of the umbilicus into the abdominal wall is normal. Operative treatment is difficult, usually due to small underdeveloped abdominal cavity. So called "Chimney Method" using synthetic mesh and as well as use of hyperalimentation improve survival rate.
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