Treatment

Emergency care for an omphalocoele includes the insertion of an orogastric tube to decompress the stomach and prevent bowel distension caused by the swallowing of air. If the patient must be transferred then the omphalocoele must be covered with a saline soaked sterile dressing or cling film to prevent fluid loss.

The patient's overall condition and associated anomalies have to be assessed before embarking upon surgery. Large defects or chromosomal trisomies usually warrant topical application of an escharotic agent. Topical therapy may be used as a temporary measure when the patient is in heart failure; repair being delayed until the patient's cardiopulmonary status has improved. Prognosis varies according to the size of the defect and the other conditions present.

The treatment of exomphalos depends on the type:

• exomphalos minor - the hernia can be reduced. The umbilical cord is twisted and the sac pushed back into the peritoneal cavity through the narrow umbilical opening. It is retained by firm strapping which must be kept for 14 days.
• exomphalos major - immediate operation is necessary before the sac bursts. The infant should not be fed so as to prevent further distension of the sac. Immediate operation and antibiotic therapy has been able to save a small number of infants with a ruptured sac.