Abdominal wall and umbilical disorders — branching viva

Opening — framing the problem

The examiner begins: a baby is delivered at a tertiary centre at 37 weeks, and at birth loops of thickened bowel protrude through a small defect to the right of a normally inserted umbilical cord with no covering membrane. Talk me through your approach. [3]

I would frame this as gastroschisis, distinguished from omphalocele by the bare bowel beside a normally inserted cord and the absence of a covering sac. My priorities would be to protect the bowel, to resuscitate the baby, and to involve the neonatal surgical team, because the exposed bowel loses heat and fluid rapidly and needs urgent stabilisation before closure. [2] [3]