1. Abdominal wall, umbilicus, omenteum
Sabiston

2. Abdominal wall Musculoaponeurotic structure Attachments
Defects: congenital, acquired,iatrogenic

3. Anterior abdominal wall
Protect viscera
Respiratory function
Urination
defecation

4. Anatomy 1. Skin 2. SubQ 3. Scarpa fascia 4. Ext. Abd. Oblique M
5. Int Abd. Oblique M
6. Transversus abd.
7. Transversalis fascia: hernia
8. Extraperitoneal fat
9. Parietal peritoneum

5. Lymphatics Above umb: Below umb: ipsilateral axillary LN
ipsilateral superficial inguinal LN

6. Blood supply Superior epigastric A Inferior epigastric A
from int. thx. A
Inferior epigastric A
from ext. iliac A
Lower intercostal
Iliac circumflex arteries

7. Congenital abnormalities
Diastasis recti: most common
Weakness of linea alba
No treatment
Omphalocele
Gastroschisis

8. Case
Neonate with protrusion in the umbilicus

12. Exomphalos and gastroschisis
Two different congenital anomalies
Differ markedly in their clinical appearance
Overall incidence is approximately 1: 3000 live births
Usually diagnosed prenatally on ultrasound

13. Exomphalos Sac contains intestinal loops, liver, spleen and bladder
Often associated with other major congenital anomalies
Prognosis depends on theses associated anomalies
Mortality is approximately 40%

14. Exomphalos Often associated with other major congenital anomalies
Prognosis depends on theses associated anomalies
Mortality is approximately 40%

15. Gastroschisis A gastroschisis never has a sac
Umbilical cord arises from normal place in abdominal wall
Usually to the left of the abdominal wall defect
Evisceration usually only contains intestinal loops
Rarely associated with major congenital anomalies

16. Exomphalos Rx Treatment depends on the size of the lesion
Aims of treatment are to reduce contents into small abdominal cavity
If bowel is covered there is no urgency to do this

20. Gastroschisis
Infants have better prognosis than those with an omphalocele
Mortality is approximately 10%

21. Rx usually direct full-layer closure of abdominal wall
May be associated with postoperative gut dysfunction
Usually require postoperative nutritional and ventilatory support

22. Granuloma: silver nitrate

23. Omphalomesenteric duct
Midgut-yolk sac
Polyp: excision
Sinus: sinogram, excision
Persistent omphalomesenteric duct
Cyst: volvulus
Meckel’s diverticulum

24. Urachus
Umb/bladder
May become infected
Diverticula of bladder

27. Omentum
Double endothelium
Vessels
Lymphatics
Nerves
Fat

28. Omentum Large in obese Can be removed Policeman of the abdomen
Movement by intestine
Can adhere firmly

29. Omentum Torsion Cysts Solid Tumors Vascular pedicle flap: neck/knee
-Wrap anastomosis, lymphedema, liver for hemostasis, biliary leak, chest wall reconstruction