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Omphalocele and gastroschisis are both abdominal wall defects that can occur in a neonate. Each results in a variable extent of herniation of abdominal contents and both are considered urgent surgical procedures. If left untreated, bowel ischemia, bowel obstruction, and sepsis can occur. Although omphalocele and gastroschisis can be similar in appearance, they have distinct characteristics (Table 142-1).

TABLE 142-1Characteristics of Omphalocele and Gastroschisis


In normal development, by the third week of gestational age, the gastrointestinal tract is formed into the foregut, midgut, and hindgut. During 7–12 weeks of gestational age, the midgut is extruded into the umbilical cord due to rapid growth and usually returns to the abdominal cavity during the 10th week of gestational age, once the abdominal cavity is large enough to accommodate the developing gut. It is thought that omphalocele and the accompanying small abdominal cavity results from an incomplete fetal return of the midgut to the abdominal cavity during development.

Gastroschisis is believed to be an isolated abdominal wall defect caused by failure in development of one of the embryonic lateral folds, causing abnormal development of the right omphalomesenteric artery or right umbilical vein. Although both omphalocele and gastroschisis result in an underdeveloped abdominal cavity, the actual etiology of each of these lesions is not completely understood.



Both omphalocele and gastroschisis pose several challenges to the pediatric anesthesiologist. Although repair of these lesions is considered urgent in nature, a careful and thorough assessment of possible associated defects is imperative. Preoperative management should focus on aggressive fluid resuscitation (150–300 mL/kg/day), avoiding hypothermia and heat loss, treating and preventing infection or sepsis, and protecting the herniated organs from direct ...

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