Pre- and postnatal botulinum toxin abdominal wall muscle relaxation in hepato-omphalocele

Giant omphalocele poses a conflict between eviscerated content and abdominal capacity, with associated risks such as compartment syndrome or cardiovascular compromise.

We present the case of a prenatally diagnosed hepato-omphalocele, without associated abnormalities. At week 37, botulinum toxin was injected in the right hemiabdomen under fetal and maternal sedation. Following Cesarean section, scheduled at week 39, injection was completed in the left hemiabdomen, and full hepatic content reduction and total amnion inversion were achieved. Definitive repair with component separation was carried out on day 8 postnatally, and the patient was discharged on day 14.

Botulinum toxin induces muscle relaxation, which can help reintroduce the eviscerated content within the abdominal cavity. The maximum effect is achieved following two weeks, which means prenatal injection may favor early amnion inversion, thus reducing hospital stay.