Congenital Anomalies of Anterior Abdominal Wall

Dr. Hatem ElGoharyLecturer of General Surgery – Helwan University

What is Hernia?

A hernia is a protrusion of a viscus or part of a viscus through an abnormal opening in the walls of its containing cavity.

Umblical hernia

Cause: Incomplete closure of the early natural umbilical defect and the absence of umbilical fascia.

Its Covered by skin .

boundaries of the umbilical ring are as follows: Superior and inferior—the umbilical ring is related to the linea and the rectus sheath on each lateral side (right and left) .

Treatment:

Before 2 Years COSERVE

After 2 Years Surgical Repair

(omphalocele ) ExomphalosOccurs once in every 6000 births.

Cause: failure of all or part of the midgut to return to the coelom during early fetal life .

Sac: very thin, it consists of two layers – an outer layer of amniotic membrane and an inner layer of peritoneum.

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Treatment

Non Operative The intact sac is painted daily withantiseptic solution and, if successful, granulisation tissue grows in from the periphery and the subsequent ventral hernia can be repaired later.

Skin flap closureThe sac is gently trimmed away enabling inspection of theabdominal contents. The skin is freed from the fascial edges and undermined laterally.

GastroschisisCongenital defect of the anterolateral abdominal wall to the right or left of the midline. The ring is formed by all layers of the abdominal wall .

Treatment ….Reduction of intestine Surgical repair

Quick RevisionUmbilical Hernia: Incomplete closure of early natural umbilical defect; absence of umbilical fascia Superior and inferior—linea alba Lateral—rectus abdominis muscle.

Omphalocele Herniation of intraperitoneal viscera into open umbilical ring Umbilical cord; hernial saccovered by double layer of membranes (amniotic outside, peritoneum inside).

Gastroschisis Defect of anterior abdominal wall toright or left of the midline.

Any Questions?

Congenital Inguino-scrotal Disorders

Embryology

The testis develops from the urogenital ridge on the posterior abdominal wall.

Gonadal induction to form a testis is regulated by genes on the Y chromosome. During gestation, the testis migrates down towards the internal ring, guided by mesenchymal tissue (gubernaculum). Inguinoscrotal descent of the testis is mediated by testosterone from the fetal testis .

A tongue of peritoneum precedes the migrating testis through the inguinal canal (the processus vaginalis).

This peritoneal pouch normally becomes obliterated after birth but failure of this process can lead to the development of an inguinal hernia or hydrocele.