Exomphalos: management problems in the tropics

Twenty-six neonates presenting to Ahmadu Bello University Hospital, Zaria, with omphalocele were reviewed. Most sacs were heavily contaminated and some babies were hypothermic on admission. Treatment in most cases followed the standard textbook practice of attempting primary closure. In the absence of mechanical respiratory support, deaths (42.3%) were usually caused by respiratory failure and septicaemia. It is suggested that in the tropics, because of our limitations, conservative management should probably be the rule rather than the exception. Primary fascia or skin closure should only be cautiously carried out for the small defects. For babies with ruptured omphalocele a surgical glove may be substituted for silastic sheet coverage.