Newborn with an omphalocele and ventricular septal defect.

This baby boy was the 4,465-gram product of a 37-week gestation to a 39-year-old G2P2 female. The pregnancy was complicated by ultrasonography that revealed an omphalocele as well as ventricular septal defect and possible tetralogy of Fallot. Prenatal surgical consultation was obtained. Robert Listernick, MD, moderator: Just to be clear, what’s the difference between an omphalocele and gastroschisis? Marleta Reynolds, MD, pediatric surgeon: Omphalocele is a defect of the abdominal wall due to failure of fusion of the umbilical ring. Intestinal contents herniate through the defect covered by a sac, unless it has ruptured. There’s a high incidence of associated extraintestinal defects. In gastroschisis, the defect is always to the right of an intact umbilicus. It results from rupture of a dysplastic abdominal wall or a vascular defect. There is neither a sac nor any associated defects. Dr. Listernick: What issues should be addressed at this prenatal consultation? Kathy Barsness, MD, pediatric surgeon: We need to discuss both treatment of the omphalocele as well as the potential for associated anomalies. Dr. Listernick: Let’s start with the omphalocele itself. Dr. Barsness: The outcome is highly dependent on the size of the omphalocele and the state of the omphalocele sac. For a very small omphalocele, often called a