An abdominal catastrophe such as a ruptured omphalocele or a gastroschisis can be alarming at rst, but a calm and measured approach is neces­sary in both situations. The rst priority of the treating team is to prevent sepsis, hypothermia, and dehydration. Where feasible, immediate reduction can be achieved in the obstetric operat­ing room provided the center is equipped for intensive monitoring of abdominal compartment syndrome. Where immediate or primary closure is not possible or carries a high risk of abdominal compartment syndrome, a sterile silastic silo bag must be applied. In case the child must be trans­ported to another facility, care must be taken not to injure or aggravate the inammation of the bowel. The infant may be wrapped in a sterile plastic sheet to prevent loss of uid and heat as well as to prevent contamination of the exposed bowel. Delayed closure can then be undertaken at a well-equipped facility. During closure, the sur­geon needs to keep an eye on lower limb perfu­sion and ventilatory pressures. Decreased lower limb perfusion which can be identied by the use of a saturation probe on the foot and increased ventilatory pressure requirements to deliver tidal volume indicate raised intra-abdominal pressure. The surgeon may in this case opt to create a ven­tral hernia by closing the skin and without clos­ing the fascia. Alternatively, lateral release incisions may be placed on the skin and fascia. Gastroschisis is often associated with intestinal atresia. However, exposure to amniotic uid in utero renders the bowel edematous and inamed, unsuitable for resection and anastomosis. Therefore, it may be necessary to re-operate on the patient for an atresia a few days after closure.