Innovative surgery helps Hendrix overcome rare birth defect

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At just 14 months old, Hendrix Ayala became one of the first babies in Iowa to undergo a Botox®-assisted repair for a giant omphalocele. With the rare birth defect, some of his organs developed outside of his abdomen within a protective sac.

The complex condition typically requires months to years of treatment before the organs can be surgically placed back into the child’s belly and safely closed.

Thanks to the expertise of MercyOne Des Moines pediatric surgeon Ulises Garza Serna, MD, Hendrix’s abdominal wall was successfully closed in months, not years, enabling the toddler to enjoy a more normal life and reach his developmental milestones sooner.

Unexpected revelation

The emotional journey began when Hendrix’s parents, Riley and Alberto Ayala, found out through prenatal testing that something was wrong. Their son would be born with a massive abdominal wall defect.

“At 20 weeks, our son’s ultrasound showed some abnormalities,” Riley recalled. “That was scary to hear. We ended up getting referred to a high-risk doctor who told us, ‘This is what it is. His insides are on the outside of him, and this is what we’re going to do.’”

Omphalocele occurs in one out of 4,000-6,000 births, affecting boys and girls equally. Its cause is unknown. In the fetus, abnormal abdominal wall development occurs around the third week, when abdominal muscles do not close properly around the umbilical cord.

After his birth, Hendrix spent 54 days in the MercyOne Children’s Hospital William and Josephine Norkaitis Neonatal Intensive Care Unit while specialists managed his high-level care. Once a layer of skin developed over the protective sac of the omphalocele, Hendrix was able to go home from the hospital with his abdominal area wrapped while his body had time to grow.

Wait or act

Typically, with giant omphalocele, the liver and intra-abdominal contents are outside the abdomen. Treatment often involves waiting several years to repair and close the abdomen. At first, Dr. Garza recommended waiting until Hendrix was 4 -or 5 years old before having surgery.

Then, he learned about an innovative technique using Botox® injections to repair the defect in months instead of years. The neurotoxin relaxes and elongates the abdominal wall muscle to create more space, making it possible to close the defect.

“I proposed to the family a new approach using Botox® for the abdominal wall to accelerate the process and allow Hendrix to reach milestones, such as walking and motor development sooner,” Dr. Garza said.

Grateful parents

Excited for a new alternative, Riley and Alberto agreed. “When I heard Botox® injections could help relax the abdominal muscles and let gravity do its job, I said ‘OK, now we’re talking!’”

The Botox® had the desired effects. “What we saw in the first four weeks was that the defect was reducing in size, and we decided to try a second round,” Dr. Garza said. “Eventually, we were able to successfully close the abdominal wall. Hendrix did amazing! To our knowledge, this is the first case done with this approach in the state of Iowa.”

Hendrix was discharged from the hospital on Nov. 15, 2025. While he may need more procedures as he grows, he’s a healthy, happy little boy.

“He’s been thriving ever since. He’s been meeting milestones slowly, but he’s getting there,” his proud mother said.

Dr. Garza concluded, “We’re so excited and so happy for Hendrix and his family.”