Omphalocele

An omphalocele involves displacement of the intestine or other abdominal contents through the umbilical root; these contents are covered only by the abdominal membrane and not skin. In children with this condition, the intestines easily can be seen through the membrane.

This is a rather frequent abnormality of the newborn. In 25 to 40 percent of children with this condition, other birth defects are present, such as heart defects and other congenital problems.

Immediately after the baby is born, the defect is covered with warm, moist sterile cloths. A tube is inserted into the baby’s stomach to prevent choking. The surgery is done as soon as the infant is stable.

While the baby is asleep under general anesthesia, an incision is made to remove the sac membrane. The bowel is examined closely to look for signs of damage or additional birth defects. Damaged or defective tissue is removed, and the healthy edges are stitched together. A tube is inserted into the stomach and out through the skin. This is called a gastrostomy tube (or G-tube). The organs are placed into the abdomen, and the incision is closed, if possible. Sometimes that is not possible, and a silo is used. The sac is covered with this silo and stitched into place. Slowly, over time, the abdominal contents are pushed into the abdomen, and the volume of the silo is decreased. When the abdominal contents fit comfortably, the silo is removed and the abdomen is stitched closed.

The baby is taken to a neonatal intensive care unit (ICU) after surgery and kept warm in an incubator. Oxygen is given, and mechanical ventilation often is required. IV fluids and pain medication are given. A nasogastric tube is kept in place to keep the stomach emptied of gastric fluids. Feedings are started by the nasogastric tube as soon as the bowels start functioning. Feedings are started very slowly, and the babies often are not willing to eat. These babies need lots of encouragement.

Complete recovery is expected, but frequently other conditions are associated with an omphalocele. How the baby does depends on these conditions.

As with any surgery, there is a risk associated with anesthesia as well as risks of intestinal infection and bleeding.

For an appointment with a Washington University pediatric surgeon, call (314) 454-6022, Monday-Friday, 8 a.m.-5 p.m.