Ultrasonic Doppler measurements of visceral blood flow in the repair of giant omphalocele.

An ultrasonic Doppler device was used for visceral perfusion monitoring in the repair of a giant omphalocele. A full-term newborn, antenatally diagnosed as having middle celosomia involving the entire liver, stomach, spleen and small intestine, underwent a staged repair following the method of Gross after visceral compression induced by periodically squeezing a Dacron membrane silo. The hilum of the omphalocele was semicircular and measured 70 mm in diameter; the membrane was kept intact. The blood flow of the abdominal inferior vena cava (IVC), hepatic vein (HV) and portal vein (PV) was serially examined. During the 11-day process of repair, the data consistently showed an IVC flow of over 60 ml/min, a PV flow of over 100 ml/min, and an IVC pressure of under 15 mmHg in this patient, whose birth weight was 3024 g. These values were closely correlated with the clinical status and the ultrasonographic findings showing angulation and decompression of the IVC and HV by visceral contents. Ultrasonic Doppler blood flow measurement provides a sensitive, noninvasive indicator of visceral organ viability during omphalocele repair.