Clinical Presentation and the Outcome of Management of Neonatal Abdominal Wall Defects at Gezira National Centre for Pediatric Surgery, March 2008 to February 2013
Abstract
Objective: Anterior abdominal wall defects represent unique challenges to pediatric
surgeons and offer insight into normal fetal development. Our main goal is to study the ation and the outcome of management of abdominal wall defects in neonates managed at Gezira National Centre of Pediatric Surgery.
Patients andMethods: This is a retrospective, prospective, descriptive hospital based
study of patients presenting with clinical aspects of abdominal wall defects who were admitted to hospital in Gezira National Center of Pediatric Surgery (GNCPS) in Gezira state, Sudan, over 5years between March 2008 and Feb. 2013.
Results:The common age group is neonates, and most cases presented earlier than 24
hours (64.1%). Regarding the presenting symptoms, (33.3%) presented with eviscerated the small intestine was the most commonly eviscerated in (17.5%), and the liver
was eviscerated in (4.8%). The operative mortality was 30 %. T he analysis of the type of found that: 13 patients (20.6%) were delivered vaginally at hospital, 10
patients (15.9%) were delivered by C/S, and 40 patients (63.5%) were delivered vaginally
According to the management, surgery was done to 30 cases (47.6%), non
surgical treatment done for 33 cases (52.4%) with good outcome. Primary closure was done for 20 cases (66.7%), Blood bank bag operation underwent for 6 cases (20.0%), and delayed hernia defects repair was done for 4 cases (13.3%). The trend in the centre is to conserve patients with intact membrane. Those with ruptured omphalocele, gastroschisis bowl obstruction will undergo urgent surgery. The analysis of the which revealed: Mortality of 9 cases (30%) the majority was due to failure and sepsis. Six cases had late complications (20%) were ventral hernia, and 27 cases had early complications (50%) most of these were
The overall mortality (30 %) can be explained by the lack of neonatal
intensive care unit and unavailability of long term total parenteral nutrition. In Lukman
study the mortality rate was 30.4% which is similar to ours (13). The overall survival in
children with omphalocele and gastroschisis is now reduced to less than 10 % in
developed countries especially in isolated cases without chromosomal anomalies or major
organ malformation(17).
Conclusion: The management of the anterior abdominal wall defect is challenging and
need urgent intervention. Early presentation improves the management out come and
decreases the mortality and complications, this need proper antenatal care follow up.
References
2- Iyekeoretin Evbuomwan.Kokila Lakhoo. Paediatric Surgery: A Comprehensive Text for Africa is published in 2011.
3- [Guideline] Finnish Medical Society Duodecim. Ultrasound scanning during pregnancy. EBM Guidelines. Feb 15 2008.
4- Cooney D. Defects of the Abdominal Wall. Pediatr Surg. 1998;2:1045-1070.
5- Langer JC. Gastroschisis and omphalocele. Semin Pediatr Surg. May 1996;5(2): 124-
8.
6- Ledbetter DJ. Gastroschisis and omphalocele. Surg Clin North Am. Apr
2006;86(2):249-60, vii.
7- Salihu HM, Boos R, Schmidt W. Omphalocele and gastrochisis. J Obstet Gynaecol. Sep 2002;22(5):489-92.
8- Wakhlu A, Wakhlu AK. The management of exomphalos. J Pediatr Surg. Jan 2000;35(1):73-6.
9- Moon S , Jung S , Park K. Ruptured fetal omphalocele complicated by midgut volvulus with strangulation. January 2009;44:1:303-304.
10- De Lorimier AA, Adzick NS, Harrison MR. Amnion inversion in the treatment of giant omphalocele. J Pediatr Surg. Jul 1991;26(7):804-7
11- De Ugarte DA, Asch MJ, Hedrick MH, Atkinson JB. The use of tissue expanders in the closure of a giant omphalocele. J Pediatr Surg. Apr 2004;39(4):613-5.
12- Kilbride KE, Cooney DR, Custer MD. Vacuum-assisted closure: a new method for treating patients with giant omphalocele. J Pediatr Surg. Jan 2006;41(1):212-5.
13- Lukman O Abdur-Rahman, Nasir A Abdulrasheed, James O Adeniran
Paediatric Surgery Unit, Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria, African Journal of Paediatric Surgery, 14-Oct-2011.
14- Al Talabani J, Shubbar AI, Mustafa KE. Major congenital malformations in United Arab Emirates (UAE): need for genetic counselling. Ann Hum Genet. 1998 Sep; 62 (Pt 5):411-8.
15- Dykes EH. Prenatal diagnosis and management of abdominal wall defects. Semin Pediatr Surg. May 1996;5(2):90-4.
16- Wada M, Kato T, Hayashi Y, et al. Intestinal transplantation for short bowel syndrome secondary to gastroschisis. J Pediatr Surg. Nov 2006;41(11):1841-5. 17- Bradnock TJ, Marven S, Owen A, et al. Gastroschisis: one year outcomes from national cohort study.BMJ. Nov 15 2011;343:d6749.
Tan KH, Kilby MD, Whittle MJ, et al. Congenital anterior abdominal wall defects in England and Wales 1987- 93: retrospective analysis of OPCS data. BMJ. Oct 12 1996;313(7062):903-6.
