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Exomphalos: management problems in the tropics.

J T Momoh

    Annals of Tropical Paediatrics
    |June 1, 1982
    PubMed
    Summary
    This summary is machine-generated.

    Conservative management is recommended for omphalocele (a congenital abdominal wall defect) in tropical settings due to resource limitations. This approach may improve outcomes compared to primary closure attempts, especially in cases of respiratory compromise.

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    Area of Science:

    • Pediatric Surgery
    • Neonatal Care
    • Tropical Medicine

    Background:

    • Omphalocele, a congenital abdominal wall defect, presents significant challenges in neonates, particularly in resource-limited tropical environments.
    • High rates of sac contamination and hypothermia were observed in neonates with omphalocele upon admission.
    • Standard textbook primary closure techniques were frequently attempted, despite potential complications.

    Purpose of the Study:

    • To review the outcomes of omphalocele management in neonates at Ahmadu Bello University Hospital, Zaria.
    • To evaluate the effectiveness of standard treatment practices in a tropical setting.
    • To propose alternative management strategies considering local limitations.

    Main Methods:

    • Retrospective review of 26 neonates diagnosed with omphalocele.

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  • Analysis of treatment approaches, including primary closure attempts.
  • Assessment of mortality causes, focusing on respiratory failure and septicemia.

    • Main Results:

    • A high mortality rate of 42.3% was recorded, primarily due to respiratory failure and septicemia in the absence of mechanical respiratory support.
    • Most omphalocele sacs were heavily contaminated, and a significant number of neonates were hypothermic at presentation.
    • Primary closure was the predominant treatment strategy employed.

    Conclusions:

    • Conservative management should be prioritized over primary closure for omphalocele in tropical regions due to resource constraints and associated risks.
    • Cautious primary fascia or skin closure may be considered only for small omphalocele defects.
    • In cases of ruptured omphalocele, a surgical glove can serve as a viable alternative to silastic sheeting for sac coverage.