PMC7303742_01
Ultrasound images of the omphalocele. (a) 13 + 4 weeks ultrasound: in the first trimester, the omphalocele contained the liver (L), the intestine (I), and part of the stomach (S). (b) 33 weeks ultrasound: the content of the omphalocele became only hepatic (L), being the stomach (S) correctly situated at the left side of the abdomen. (c) 37 weeks ultrasound: estimation of the final size of the omphalocele before the elective caesarean section.
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An omphalocele enclosing mixed intestinal and hepatic content was diagnosed at 12th week (Figure 1(a)). At 21st week, the omphalocele content became only hepatic (Figure 1(b)). At 37th week the estimated bag size was 51 x 56 mm (Figure 1(c)).
Elective cesarean section. (a) Appearance of the omphalocele at birth. (b) Immediate neonatal care: placement of a thermal bag covering the whole baby's body.
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Test 9-10, and pH 7.32 (Figure 2(a)). A thermal bag covering the whole baby's body was placed immediately after the birth to maintain body heat and reduce the risk of infection (Figure 2(b)). The baby was admitted in the Neonatal Ward for management and surgical preparation in the first hours, starting parenteral nutrition after childbirth.
Surgical intervention. The total hepatic content of the omphalocele (a) is visualized. Surgical repair by primary closure of the defect (b). Image of the newborn after intervention (c).
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A primary closure of the herniation was the first choice, though mesh repairing using a synthetic patch was considered depending on the intra-abdominal pressure (IAP), which was monitored throughout the intervention. As IAP was 15 cm H2O, a primary closure of the defect was performed (Figures 3(a), 3(b), and 3(c)).
Revision at 3 months of age showing new bilateral inguinal hernia (a). Left hernia repair: the ileocecal junction and the appendix were observed inside (b) and appendicectomy was performed. Image of the baby's abdomen at 4 months of age (c).
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At 3 months of age, two inguinal hernias were diagnosed and repaired surgically (Figure 4(a)). Due to this abnormal location, a prophylactic appendectomy was performed (Figure 4(b)). Currently, the baby is one year old and he is alive and well (Figure 4(c)).