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Mentor : dr. Amran Sinaga, Sp B :: By :: Luli Yuanna Futri S.

Ked

Omfalokel is a septal (disability) on the anterior abdominal wall at the base of the umbilical cord with herniation of abdominal contents. The herniation organs are wrapped by the parietal peritoneum.

At the beginning of the 3rd week of embryonic development, the digestive tract is divided into foregut, midgut and hindgut.

Head folds (cephalic fold) Location in front of the containing the foregut that forms the pharynx, esophagus and stomach. Crease the side (lateral fold) Wrapping midgut and form a ring with the other folds early umbilicus. Crease the tail (caudal fold) Wrapping hindgut which will form the colon and rectum.

1. High risk pregnancy 2. Folic acid Deficiency 3. Polyhydramnion

Fetal in 5-6 week, abdominal contents located outside of embryo at selom cavity. At 10 weeks going on the development lumen of the abdomen so the intestinal from extra peritoneum will go into the abdominal cavity stagnant There will be a bag at the base of umbilicus that contains the intestines, stomach sometimes hepar.

One of theory is that the omphalocele develop due to failure of embryonic migration and fusion of the cranial part fold, caudal and lateral to the umbilicus when forming a ring on the center line before the invasion myotomes at week 4 of development.

Prenatal Diagnose USG Postnatal Diagnose clinical appearance o There is a central defect in the abdominal wall of the umbilical cord are o Diameter starts from 4 cm until 12 cm o Herniation of abdominal organs contain both solid and hollow o Still covered by a membrane or bag and looked at the height of the umbilical cord inserts into pockets.

Prenatal
Omphalocele diagnosed during prenatal, informed consent should be performed to the parents about the state of the fetus, the mothers risk, and prognosis. The final decision is needed for the planning and subsequent treatment such as continuing of pregnancy or terminate pregnancy

Postnatal
1. Place the baby in a warm room for aseptic and prevent fluid loss, hypothermia and infection. 2. Place the baby as comfortable as possible and gently to avoid baby crying and swallowing water. 3. Assess presence / absence of respiratory distress.

4. Attach NGT 5. Attach catheter 6. Attach an intravenous line 7. Perform monitoring and stabilisiasi temperature, acidbase status, fluid and electrolyte 8. Defect was closed with a sterile-saline or povidone-iodine 9. Evaluation of other congenital abnormalities

Indication : 1. Giant omphalocele 2. Neonatus with a disorder that raises complication in surgically. 3. A baby with abnormalities that greatly affects the durability of life.

Primary Closure Staged Closure o skin flap

o silo (Silastic
reinforced with Dacron)

Primary closure Treatment of choice on small and medium omphalocele. Do the omphalocele with defect diameter <5 cm. Staged closure In the case of large omphalocele. Do the omphalocele with defect diameter> 5 cm.

1. Dehidration & Hypothermia

2. Infection
3. Nutritional deficiencies 4. Sepsis 5. Necrosis

Survive omphalocele rate in infants is influenced by the following ways: Prematurity Omphalocele size

The anomalies in other


organs.

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