This document discusses several congenital abdominal wall anomalies: - Umbilical hernias are caused by incomplete closure of the umbilical defect and absence of fascia. They are covered by skin and bounded superiorly/inferiorly by the linea alba and laterally by the rectus muscles. Treatment before 2 years is observation, after 2 years is surgical repair. - Omphaloceles involve herniation of intestines into an open umbilical ring through a very thin sac. Non-operative treatment involves cleaning the sac daily until it closes. Surgical options include skin flap closure or sac removal to inspect organs. - Gastroschisis is a defect to the right or

1. Congenital Anomalies of
Anterior Abdominal Wall
Dr. Hatem ElGohary
Lecturer of General Surgery – Helwan University

2. 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.

3. 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).

5. Treatment:
Before 2Years COSERVE
After 2Years Surgical Repair

6. (omphalocele)Exomphalos
Occurs 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.
.

7. Treatment
Non Operative
The intact sac is painted daily with
antiseptic solution and, if successful, granulisation tissue grows
in from the periphery and the subsequent ventral hernia can
be repaired later.
Skin flap closure
The sac is gently trimmed away enabling inspection of the
abdominal contents.The skin is freed from the fascial edges
and undermined laterally.

8. Gastroschisis
Congenital 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.

9. Treatment ….Reduction of intestine
Surgical repair

10. Quick Revision
Umbilical 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 sac
covered by double layer of membranes (amniotic
outside, peritoneum inside).
Gastroschisis Defect of anterior abdominal wall to
right or left of the midline.

11. Any Questions?

12. 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 theY 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.

13. 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.