THE PATHOGENESIS OF OMPHALOCELE AND GASTROSCHISIS - AN UNSOLVED PROBLEM

The embryology of gastroschisis and omphalocele remains a matter of sp eculation. Most authors still assume that they represent seperate enti ties with a different pathology and embryology. In contrast, others fe el that gastrochisis is simply the end-result of a ruptured omphalocel e. Reviewing the current literature on the normal and abnormal embryol ogy of the anterior abdominal wall, it becomes obvious that appropriat e embryological knowledge of these processes is still missing. Animal models are not at hand that would allow clear definitions of morpholog ical changes unique to either malformation. Nevertheless, our own obse rvations of the pathological anatomy of these anomalies lead us to bel ieve that the abdominal wall defects are the result of disturbed devel opment of the embryonic umbilicus. This includes gastroschisis, which is more likely a ruptured small omphalocele than a developmental entit y of its own. In our view, the common ventral abdominal wall defects f all into two main categories: (I) large omphaloceles; and (2) small om phaloceles, with gastroschisis as a subentity of this lesion.