Abdominal wall and umbilical disorders — formative SAQs

SAQ 1 — The newborn with exposed bowel (10 marks, 15 minutes)

A baby is delivered at 37 weeks by a planned caesarean at a tertiary centre. At birth, loops of thickened, oedematous bowel are seen protruding through a small defect to the right of an otherwise normally inserted umbilical cord. There is no covering membrane over the bowel. ^[3]

a) What is the diagnosis, and state the two anatomical features that distinguish it from the alternative congenital wall defect. (2 marks) ^[1]

b) Explain the embryological basis for this defect and why it is usually isolated, in contrast to the alternative which carries chromosomal and cardiac associations. (3 marks) ^[2]

c) Outline your immediate resuscitation, including how you would protect the bowel, your fluid management and the role of antibiotics and parenteral nutrition. (3 marks) ^[2]

d) Describe the two surgical options for definitive closure and the factor that determines the choice between them. (2 marks) ^[1]