Abdominal Wall

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Abdominal Wall
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Stomach
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Abdominal Measurement
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Abdomen Circumference
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Normal Cord Insertion Site
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Fetal Gallstone
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CORD INSERTION
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Abdominal Wall Defects

• Ectopia cordis
• All or part of the heart is located outside of
  the chest cavity
• It is associated with intracardiac anomalies and
  omphaloceles
• By ultrasound, you can see the heart beating
  outside the thorax

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Ectopia Cordis

• By ultrasound, you can see a small thorax with
  tissue noted outside the thoracic cavity
• The prognosis is very poor
• Associated with facial and skeletal deformities,
  and meningoceles

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Ectopia Cordis
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Ectopia Cordis
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Ectopia Cordis
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Ectopia Cordis
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Ectopia Cordis
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Anterior Abdominal Wall Defects

• Abdominal wall defects can be R/O with abdominal
  circumference measurements
• Omphalocele
• Results from a failure of the intestines to
  return to the abdomen during the second stage of
  intestinal rotation
• May consist of a single loop of bowel or may
  contain most of the intestines, liver, etc.
• Most frequent ventral wall defect
• A weakness in the abdominal wall muscles
  specifically the rectus abdominus muscle
• Incidence of 2-2.5 fetus per 10,000 live births

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Omphalocele

• 90 are associated with abnormal chromosomal
  defects which include trisomy 13, 18 and 21,
  triploidy and Turners Syndrome
• Incidence of chromosomal abnormalities is lower
  if the omphalocele contains liver and the
  incidence is higher if it contains only bowel

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Omphalocele

• Midline and smooth walled
• It occurs at the level of the umbilical cord
  insertion site where the cord inserts into the
  outpouching
• These fetuses are at high risk for other
  abnormalities that include
• Cardiac anomalies (47)
• Genitourinary abnormalities (40)
• Neural tube defects (39)
• Trisomies (35-58)

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Omphalocele

• AFP increased but not as high as with
  gastroschisis
• Ultrasound appearance outpouching of the
  abdominal wall at the level of cord insertion
  site
• The outpouching may contain liver and bowel, it
  can also contain the spleen, stomach and bladder

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Omphalocele

• It is covered by peritoneum
• Fetal ascites should be visualized only with an
  omphalocele because the absence of a covering
  membrane in gastroschisis allows ascites to
  escape into the surrounding amniotic fluid
• It is associated with chromosomal abnormalities

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Omphalocele

• It is important to distinguish between
  omphaloceles and gastroschisis because
  omphaloceles are usually associated with
  underlying chromosomal abnormalities
• Cord inserts into the enclosed herniation of
  abdominal content

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Omphalocele
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Omphalocele
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Omphalocele
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Omphalocele
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Omphalocele
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Omphalocele
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Omphalocele
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Gastroschisis

• Essentially an isolated entity rarely associated
  with anomalies other than various types of bowel
  atresia
• Protrusion of intestines into amniotic cavity
  through an open defect in the anterior abdominal
  wall
• Incidence of 0.8-2.5 fetuses in 10,000 live births

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Gastroschisis

• Uncommonly associated with other fetal anomalies
  hence the prognosis is better than an omphalocele
  because it is usually an isolated anomaly
• Usually only the bowel is eviscerated, when you
  see gastroschisis with the evisceration of other
  organs other than bowel, the amniotic band
  syndrome should be considered and the spine and
  extremities carefully examined for anomalies

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Gastroschisis

• Usually located just to the right of the
  umbilical cord
• Bowel loops float freely in the amniotic fluid
• High AFP and polyhydramnios
• Umbilical cord will be seen displaced laterally
• No membrane is seen containing organs
• C-section is done to prevent trauma and the
  prognosis is excellent

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Gastroschisis
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Gastroschisis
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Gastroschisis
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Gastroschisis
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Gastroschisis
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Gastroschisis
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Gastroschisis
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Gastroschisis
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Gastroschisis
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Gastroschisis
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Gastroschisis
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Gastroschisis
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Gastroscschisis
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Prune Belly Syndrome

• Due to an obstructive lesion
• Absence of the rectus abdominus muscle
• The skin is intact, it is just that the muscle
  doesnt form
• This is a Triad Syndrome, that includes
• Anterior abdominal wall distention
• Urinary tract obstruction
• Cryptorchidism

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Prune Belly Syndrome

• Greatly dilated bladder and ureter
• Hydronephrosis
• Large abdominal circumference
• May see ascites
• May see descended loops of bowel
• Amniotic fluid is variable
• May occur due to radiation during the 5th-12th
  weeks of development

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Prune Belly Syndrome
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Prune Belly Syndrome
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Prune Belly Syndrome
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Prune Belly Syndrome
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Prune Belly Syndrome
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Prune Belly Syndrome
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Prune Belly Syndrome
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Prune belly syndromedistended bladder
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Prune belly dilated ureter
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Prune Belly Syndrome
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Prune Belly Syndrome
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Prune Belly Syndrome
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Prune Belly Syndrome
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Fetal Hydrops