Author(s): AbdurRahman LO, Abdulrasheed NA, Adeniran JO
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Abstract BACKGROUND: Abdominal wall defect presents a great challenge when it is large, ruptured, or associated with other anomalies. OBJECTIVE: To review the challenges and outcome of management of anterior abdominal wall defects (AAWD). MATERIALS AND METHODS: A retrospective review of omphalocele and gastroschisis managed over 8 years at our institution. RESULTS: Omphalocele (n=49) and gastroschisis (n=7) constituted 2.4\% of total admission. The median age was 23.5 hours, with male-female ratio of 1:1.1. Term infants were 91.7\% and more than 75\% weighed above 2.5 kg. The mean maternal age was 28.5±5.87 years and mean parity was 3.1±2.0, with P values of 0.318 and 0.768, respectively. More than 92.9\% of infants were out-born, 46 pregnancies (82.1\%) were booked, and 51 (91.1\%) had at least one ultrasound scan, but only 1 (1.8\%) was diagnosed with gastroschisis. Ruptured omphalocele were 11 (6 major, 5 minor) in number, 3 of which presented with enterocutaneous fistula, and 3 (6.1\%) were syndromic omphalocele. Positive blood culture confirmed septicaemia in 21 cases (37.5\%). Surgical repair was done in 35 cases (62.5\%), 44.6\% as emergency, and 17.9\% as elective. Non-operative management was done in 21 patients (37.5\%) and 5 (8.9\%) were discharged against medical advice. Median length of hospital stay was 10 days (mean, 15.98±14.38). Postoperative complication rate was 32.1\% and overall mortality was 30.4\%, with the highest case fatality among gastroschisis (57.1\%) and omphalocele major (32.1\%). CONCLUSIONS: There were large numbers of out-born infants due to poor prenatal diagnosis in spite of high instances of antenatal ultrasound scan. Many patients presented with complications that resulted in poor outcome.
This article was published in Afr J Paediatr Surg
and referenced in Clinics in Mother and Child Health