Abdominal wall and umbilical disorders — formative SAQs

SAQ 1 — The newborn with exposed bowel (10 marks, 15 minutes)

A baby is delivered at 37 weeks by a planned caesarean at a tertiary centre. At birth, loops of thickened, oedematous bowel are seen protruding through a small defect to the right of an otherwise normally inserted umbilical cord. There is no covering membrane over the bowel. [3]

a) What is the diagnosis, and state the two anatomical features that distinguish it from the alternative congenital wall defect. (2 marks) [1]

b) Explain the embryological basis for this defect and why it is usually isolated, in contrast to the alternative which carries chromosomal and cardiac associations. (3 marks) [2]

c) Outline your immediate resuscitation, including how you would protect the bowel, your fluid management and the role of antibiotics and parenteral nutrition. (3 marks) [2]

d) Describe the two surgical options for definitive closure and the factor that determines the choice between them. (2 marks) [1]

SAQ 2 — The ex-preterm infant with a groin mass (10 marks, 15 minutes)

A six-month-old boy born at 29 weeks gestation presents to the emergency department with a four-hour history of crying, refusing feeds and a hard, tender swelling in the right groin that does not reduce. He has vomited twice. In a separate clinic room, a mother asks whether she should treat her two-week-old baby's moist pink umbilical nodule with silver nitrate. [7]

a) What is the diagnosis, and why is this child at particularly high risk of this complication? (2 marks) [9]

b) Outline your immediate management, including analgesia, your approach to reduction and the indication for urgent surgery. (3 marks) [8]

c) Explain why an inguinal hernia, once diagnosed, must be referred for surgical repair rather than observed, and contrast this with the natural history of an umbilical hernia. (3 marks) [10]

d) Advise the mother on the treatment of the umbilical granuloma, comparing common salt with silver nitrate and citing the safety advantage. (2 marks) [11]