This document describes an omphalocele, which is an extrusion of fetal abdominal contents into the base of the umbilical cord. The findings in this case show a herniated anterior abdominal mass covered by membrane, with the liver and small bowel herniated. This is consistent with an omphalocele with extracorporeal liver. Omphaloceles can be associated with chromosomal abnormalities and other congenital anomalies. Ultrasound is used to diagnose omphaloceles by identifying the herniated contents and covering membranes.

1.  FREE LANCE
RADIOLOGY
Fetal sonogram with
Herniated anterior
abdominal mass
( MEDIAN) with liver
and small bowel as
contents of herniation.
The herniated contents
are covered with
membrane
( contained ) . These
findings are s/o
OMPHALOCELE
( extra corporeal liver)

2. DEFINITION PATHOGENESIS
 Intracorporeal Liver
 Extrusion of the fetal ( only bowel
abdominal contents into the herniates , No liver in the herniated
contents) . This type of omphalocele
base of the cord . is diagnosed after 12wks
 Herniated mass is covered ( physiological herniation of bowel
with parietal peritoneum is a d/d before 12 wks ) . The
etiology for this type of
and amniotic membrane omphalocele is Persistence of
with wharton’s jelly in primitive body stalk and failure of
between peritoneum and the bowel to return to abdomen
amniotic membrane. after 12wks .
 Extra corporeal liver
( only liver is herniated ) .
This type of omphalocele can be
diagnosed before 12 wks also . This
type of omphalocele is sequel to
defective growth of the lateral

3. ASSOCIATIONS
 Trisomy 18, 13, 21  The extent of the
 Turners Association with
 Klinfelter
anomalies is high when
 CNS anomalies
herniated contents have
 GI anomalies
 GU anomalies smll bowel with
 Cardiac anomalies ( 50 oligohydramnios /
%). polyhydramnios .
 Beckwith wiedmen
syndrome .
 Cloacal exstophy .

4. RADIOLOGICAL
DIAGNOSIS FINDINGS
 Anterior abdominal mass is
 MSAFP appreciated in median plane
 Acetylcholinesterase  Define the site of cord insertion
( in omphalocele cord insertion
positive . is on the apex of the herniated
mass).
 Define the covering membranes
with associated ascites .
 In ompahloccele hernaited
visera is contained ( c/f
gastroschisis where herniated
viscera is free floating and
paramedian : Rt sided ) . Due to
presence of the protective
memberanes : Bowel thickening
or dilation is not usually seen in
omphalocele ( c/f gastroschisis)

5. THE RADIOLOGICAL
RESPONSIBILITY
SUGGESTIVE …………….
 Define the appearance of  Fetal echocardiography
the omphalocele .  Karyotype .
 Look for covering
memberanes / ascites .  Delivery in tertiary care
 Define the presence /  Genetic counselling .
absence of the liver . ( intra
/ extra corporeal ) .
 Ratio of the herniated
mass to transverse
diameter of the abdomen (
>60 % in omphalocele )

6. Anterior abdominal mass
with
covering membranes .
Note is made of
herniation of the liver .

7. ANTERIOR ABDOMINAL WALL WITH
ECHOGENIC BOWEL AS HERNIATED
CONTENT .

8. MEDIAN HERNIATION OF THE ABDOMINAL
CONTENTS INTO THE BASE OF THE UMBILICAL CORD
WITH CORD INSERTION ON THE
TOP OF THE HERNIATED CONTENTS
CORD INSERTION ON THE TOP CORD INSERTION ON THE TOP
OF HERNIATION ( GREY SCALE) OF HERNIATION ( COLOR DOPPLER)