ANTERIOR ABDOMINAL

WALL DEFECTS &

GASTROINTERSTINAL
CONGENITAL
ANOMALIES
Prof.Dr. Maged Ahmed Abd Alraouf,
Cairo Univ.

STOMACH
Fetus begins to swallow at 16W so
should be seen after 18W routinely.
Can be seen as early as 13W.
Size varies depending on fluid
recently swallowed.

U/S

fluid filled stomach bubble

is seen as an anechoic crescentshaped structure in left
hemiabdomen.

LIVER
Site of hematopoiesis by 8 W .
Contributes to size of the
abdomen .

U/S
large homogenous
structure beneath the
diaphragm at the right side.

GALL BLADDER
Forms at 7 W.
Passive role in the fetus.

U/S

seen at about 20 W
small oval anechoic structure to the right of
portal/umbilical vein.

SMALL BOWEL
Appears centrally in the abdomen
.
Should not exceed 6 mm in
diameter.
More echogenic than large bowel
until late in the third trimester as
with more swallowed liquor it can
appear more sonolucent.

LARGE BOWEL
Reservoir for meconium from
small bowel so diameter
increases through pregnancy.
U/S
long tubular
peripheral hypoechoic
structure.
No peristalsis.

OMPHALOCELE

Anterior abdominal wall

defect where abdominal
contents herniates into base of
umbilical cord .
High maternal serum A F P.
Not diagnosed until after 14 W
ASSOC.
T 13 18 21
TURNER KLEINFELTER.

OMPHALOCELE
U/S

Ant. midline mass with

covering membrane
Herniation of abdominal
viscera at base of the cord
(liver ,bowel ,&/stomach )
.
Umb. cord enters the mass .
Fetal ascites .

GASTROSCHISIS

Ant . Abd . W. Defect where fetal

viscera protrude through a
paraumbilical defect to the RT
of a normally closed umb.ring.
Not diagnosed until after 14 W.
High maternal A .F .P .
Usually NO associated
anomalies so prognosis good.

GASTROSCHISIS
U/S

Multiple bowel loops (small & large )

floating freely in amniotic fluid with no
covering membrane .
( RAGGED ) edge .
Occasionaly stomach & rarely liver may
herniate
Normal insertion of umb.cord to the
LEFT of the mass.
Stomach & U.B. Close toether.
Polyhydramnios .

GASTROSCHISIS

SONOGRAPHIC
COMPARISON

GASTROSCHIS OMPHALOCEL
IS
E
No membrane
covering mass

Membrane
covering mass.

Cord inserts in
abd.wall.

Into membrane.

Bowel herniates
but stomach can
also.

Liver usually
herniates but
stomach can as
well.

BODY STALK
ANOMALY
MAJOR

ABD. WALL
DEFECT .
SEVERE KYPHOSCOLIOSIS.
RUDIMENTARY UMB. CORD.

LETHAL ANOMALY.

BODY STALK ANOMALY

U/S
MAJOR

ABD. WALL DEFECT .

SEVERE KYPHOSCOLIOSIS.
SHORT OR ABSENT UMB. CORD.
THE LIVER TYPICALLY IS
DIRECTLY ATTACHED TO THE
PLACENTA.

BLADDER EXSTROPHY

Defect of the caudal fold of the Ant.Abd.W.;

small defect causes epispadias alone
,
large defect leads to exposure of the
post. bladder wall.
U/S :suspected when in presence of normal
amniotic fluid ,the U.B. Is not seen(during
15m ) An ehogenic mass is seen protruding
from the lower Abd.W. Close to Umb.
arteries.

CLOACAL EXSTROPHY

Both U.T.& G.I.T. are involved.

Omphalocele
Exstrophy of bladder
Imperforate anus
Spinal defect as meningomyelocele
U/S
large infra umbilical defect
extends to pelvis
+
herniated
bowel
+/or meningocele.

G.I.T. ANOMALIES
EVALUATE

STOMACH ;

ABSENT
EXAM. CHEST

DIAPH . HERNIA

RECHECK

PHYS . EMPTYING

ABSENT

ESOPHAGEAL ATRESIA

ABSENT STOMACH
BUBBLE

ESOPHAGEAL
ATERSIA

May be associated with tracheoesophageal fistula .

Assoc.
VACTREL
T 13 18 21 .
U/S
absence of fluid-filled stomach
bubble.
Small A.C.

polyhydramnios.
With fistula:stomach
bubble seen.

ESOPHEGEAL ATRESIA

DUODENAL
ATRESIA

Associated with
T 21 & Cong.
Ht. Dis.
U/S
DOUBLE BUBBLE SIGN (distended
stomach & proximal duodenum )
Polyhydramnios

IUGR

After 24W.

JEJUNAL
ATRESIA

Tripple

or quadruble
bubble sign
(a cross section
cut through several
dilated loops of bowel ).

ASCITES
PsudoAscites : abdominal muscles
can appear as a thin hypoehoic rim
along the ant. Abd.w.
True ascites is always abnormal .
Associated with hydrops fetalis ,
pleural effusion, bowel
perforation,urinary tract
rupture,glycogen storage disease .

ABDOMINAL CYSTS

CHOLEDOCAL (dil.common bile

duct )
HEPATIC
OVARIAN
MESETERIC OR OMENTAL
INTESTINAL DUPLICATION