An isolated omphalocele determined in one fetus of a twin pregnancy

Objective 

Omphaloceles represent a common group of congenital midline abdominal wall defects associated with increased perinatal morbidity and mortality. Most cases occurs sporadically and an isolated omphalocele occurs in approximately one of every 1:5,000 births. Herein we objected to discuss a patient with omphalocele.

Case 

A 21-year-old G2P0A1 twin pregnant presented to our clinic due to routine follow-up. The patient having a regular menstrual cycle previously was at 21 weeks and 2 days since her last menstrual period. The patient did not have consanguineous marriage and a dichorionic diamniotic twin pregnancy at 21 weeks was determined in the ultrasonography performed. While one of the fetuses was observed to be normal, an omphalocele was determined in the other fetus (Figure 1a,b). No additional anomaly was determined in the detailed ultrasonography of the fetus observed to have omphalocele. It was learned from the history of the patient she did not have the second trimester screening tests and the third trimester screening tests previously. The patient was informed regarding there could be an additional anomaly. Since the patient was in a late gestational week and she did not want to have, amniocentesis was not performed. Routine laboratory test results were normal. The patient was followed-up with normal pregnancy follow-up and she had caesarean section at 37th week of gestation. Both of the babies were delivered alive. Newborn infant with definite diagnosis of omphalocele was referred to pediatric surgery. Repair of omphalocele defect was performed in the newborn without any additional anomaly.

Results

Concomitant congenital anomalies of the other systems are also seen in more than 40% of the babies born with an omphalocele. Prognosis is better in the isolated omphaloceles. It is important to make differential diagnosis between omphalocele and gastroschisis. In this case, abdominal visceral organs are floating in the amniotic fluid. Although umbilical cord was normal at birth, abdominal visceral organs protruded through right or left abdominal wall defect. Omphalocele is covered by a membrane consisting of small and large intestines frequently.

Conclusion 

Prenatal diagnosis of omphalocele can be made by using ultrasonography and it is important to investigate the presence of additional anomaly for prognosis. In the management of delivery of the cases diagnosed to have omphalocele, gynecologists and pediatric surgeons should collaborate with a multidisciplinary approach to prevent and treat the neonatal complications.

Keywords

Omphalocele, gastroschisis, prenatal diagnosis

	File/Dsecription
	Figure 1 Appearance of omphalocele in ultrasonography of fetus at 21 weeks of gestational age, (a) in transverse section, (b) in sagittal section.
	Figure 2