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  2. An umbilical defect
  3. An umbilical defect
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An umbilical defect

BMJ 2005; 331 doi: https://doi.org/10.1136/sbmj.0507273 (Published 01 July 2005) Cite this as: BMJ 2005;331:0507273
  1. Michael Curci, director of paediatric surgery1,
  2. Talia Hoffsetin, medical student2
  1. 1Maine Meical Center, University of Vermont College of Medicine, Burlington, VT, USA
  2. 2University of Vermont College of Medicine

During their caesarean delivery, one of three triplet fetuses, aged 31 weeks and 2 days, was noted to have a clear shiny sac protruding from the base of the umbilical cord. The defect was immediately covered with moist dressings, which upon removal had some green-yellow staining. Physical examination showed an intact membranous sac containing what seemed to be several loops of bowel. Upon closer inspection of the sac, a small stoma was discovered (figure).

Questions

  1. What is your diagnosis?

  2. What additional diagnostic investigation could be useful in this case? Is it necessary?

  3. What is the treatment of choice?

Answers

  1. There is a protrusion of abdominal contents through a mid-line defect that involves the umbilicus and a surrounding sac. It is the presence of the surrounding sac that classifies this defect as an omphalocele rather than gastroschesis (see discussion).

    The stoma is the probable source of the fluid drainage and likely represents a patent persistent omphalomesenteric duct. A ruptured omphalocele can be ruled out by the …

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