Initial conservative management of exomphalos major with gentian violet
Ashrarur Rahman Mitul1, Kmn Ferdous1
1Department of Pediatric Surgery, Dhaka Shishu (Children) Hospital Dhaka, Bangladesh.
Insights
Topical gentian violet (GV) offers a satisfactory conservative treatment for infants with exomphalos major (EM) when immediate surgical closure is not feasible. This approach can lead to a ventral hernia requiring later repair, with careful monitoring for complications like sepsis.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Clinical outcomes
Background:
- Exomphalos major (EM) is a complex congenital anomaly.
- Management of EM often requires surgical intervention.
- Conservative approaches are considered for specific patient groups.
Purpose of the Study:
- To evaluate the outcomes of topical gentian violet (GV) treatment in neonates with exomphalos major.
- To assess the efficacy and safety of conservative management with GV for EM.
Main Methods:
- Retrospective study of 37 neonates with exomphalos major (EM) treated between 2005 and 2010.
- Classification of EM based on sac diameter and content (liver).
- Conservative treatment involved topical 1% gentian violet (GV) application to the sac.
Main Results:
- Of 37 EM neonates, 27 were treated conservatively with GV.
- Four deaths occurred due to sepsis in the conservatively treated group.
- Twenty-three infants were discharged with a ventral hernia for later repair.
- Overall mortality in the EM subgroup was 37.83%.
Conclusions:
- Topical gentian violet (GV) provides a satisfactory initial conservative treatment for exomphalos major (EM).
- This approach is suitable for infants unable to undergo immediate surgical closure.
- Ventral hernia formation is a common sequela requiring planned future surgical repair.
Aim:
The purpose of the study was to assess the results of topical use of gentian violet (GV), among the babies with exomphalos major in our institute.
Methods:
The study was carried out retrospectively in a tertiary care hospital during the period from 2005 to 2010 inclusive. Exomphalos patients were classified as major if diameter was >5 cm and/or had liver in the sac as content. These patients were initially preferentially treated conservatively with topical 1% GV over the sac resultig a ventral hernia to be repaired later.
Results:
A total of 84 exomphalos patients were admitted during the study period. Among them, 37 neonates (26 males and 11 females) had exomphalos major (EM). Ten of them were prenatally diagnosed. The mean gestational age at delivery was 35 weeks, and mean birth weight was 2.1 Kg. Mean age at presentation was 3.7 days. Thirty (81%) had other associated anomalies, mostly cardiac (66.6%) and pulmonary (46.6%). Ten patients with EM needed early operation because of ruptured sac, and other anomalies. There were 2 pre-operative and 8 postoperative deaths in this subgroup. Twenty seven patients were treated conservatively, among these 4 died of overwhelming sepsis. Remaining 23 patients left the hospital with a ventral hernia planned to be repaired at 1 year of age. Overall mortality in our series was 37.83%.
Conclusion:
Initial conservative treatment of the sac with GV results in satisfactory outcome for infants with EM who cannot undergo immediate closure.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:22Aneurysm IV: Nursing Management
01:26Varicose Veins II: Diagnostic Studies and Interprofessional Care
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease