CC BY 4.0 · European J Pediatr Surg Rep. 2017; 05(01): e4-e8
DOI: 10.1055/s-0037-1599796
Case Report
Georg Thieme Verlag KG Stuttgart • New York

Delayed Closure of Giant Omphaloceles in West Africa: Report of Five Cases

Oumama El Ezzi
1   Department of Pediatric Surgery, CURCP, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
,
Raymond Bossou
2   Departement du zou et collines – Pediatry, Abomey, Benin
,
Olivier Reinberg
1   Department of Pediatric Surgery, CURCP, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
,
Sabine Vasseur Maurer
1   Department of Pediatric Surgery, CURCP, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
,
Anthony de Buys Roessingh
1   Department of Pediatric Surgery, CURCP, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
› Author Affiliations
Further Information

Publication History

06 September 2016

27 January 2017

Publication Date:
22 March 2017 (online)

Abstract

Giant omphalocele (GO) management is controversial and not easy. Conservative management at birth and delayed surgical closure is usually mandatory. Postponed surgery may be challenging and carry the risk of intensive care treatment. We report on five children who were treated in our department for GO between 2000 and 2010. Initially, the patients were managed conservatively in West Africa. Delayed closure of the ventral hernia was performed in Switzerland after patient transfer through a nongovernmental organization. Fascial closure was performed at the median age of 23 months. Median diameter of the hernias was 10 × 10 cm ranging from 10 × 8 cm to 24 × 15 cm. Four (80%) patients had associated anomalies. Three children needed mechanical ventilation in the intensive care unit after surgery. Median hospitalization was 19 days. Complications were seen in two patients. The follow-up showed no recurrence of ventral hernia. There was no mortality.

This report shows that conservative management of a GO at birth with delayed closure of the ventral hernia after transferring the patients to a European center is a safe approach for West African children and avoids life-threatening procedures. Delayed closure of a GO may be nevertheless challenging everywhere.

 
  • References

  • 1 Pelizzo G, Maso G, Dell'Oste C. , et al. Giant omphaloceles with a small abdominal defect: prenatal diagnosis and neonatal management. Ultrasound Obstet Gynecol 2005; 26 (07) 786-788
  • 2 Adam AS, Corbally MT, Fitzgerald RJ. Evaluation of conservative therapy for exomphalos. Surg Gynecol Obstet 1991; 172 (05) 394-396
  • 3 Kamata S, Ishikawa S, Usui N. , et al. Prenatal diagnosis of abdominal wall defects and their prognosis. J Pediatr Surg 1996; 31 (02) 267-271
  • 4 David KM, Robert SS, Stringer MD. , et al. Abdominal Wall Defects Pediatric Surgery and Urology: Long Term Outcomes. W.B. Saunders: London; 1998: 243-56
  • 5 Mann S, Blinman TA, Douglas Wilson R. Prenatal and postnatal management of omphalocele. Prenat Diagn 2008; 28 (07) 626-632
  • 6 Ali Nawaz Khan NT. Sumaira Mac Donald. Omphalocele. Medicine medscape com website; 2008
  • 7 Kumar HR, Jester AL, Ladd AP. Impact of omphalocele size on associated conditions. J Pediatr Surg 2008; 43 (12) 2216-2219
  • 8 Robinson JN, Abuhamad AZ. Abdominal wall and umbilical cord anomalies. Clin Perinatol 2000; 27 (04) 947-978
  • 9 Lee SL, Beyer TD, Kim SS. , et al. Initial nonoperative management and delayed closure for treatment of giant omphaloceles. J Pediatr Surg 2006; 41 (11) 1846-1849
  • 10 Tsakayannis DE, Zurakowski D, Lillehei CW. Respiratory insufficiency at birth: a predictor of mortality for infants with omphalocele. J Pediatr Surg 1996; 31 (08) 1088-1090 , discussion 1090–1091
  • 11 Campos BA, Tatsuo ES, Miranda ME. Omphalocele: how big does it have to be a giant one?. J Pediatr Surg 2009; 44 (07) 1474-1475 , author reply 1475
  • 12 Festen C, Severijnen RS, vd Staak FH. Nonsurgical (conservative) treatment of giant omphalocele. A report of 10 cases. Clin Pediatr (Phila) 1987; 26 (01) 35-39
  • 13 Mehrabi V, Mehrabi A, Kadivar M, Soleimani M, Fallahi A, Khalilzadeh N. Staged repair of giant recurrent omphalocele and gastroschisis “Camel-Litter method”-a new technique. Acta Med Iran 2012; 50 (06) 388-394
  • 14 de Buys Roessingh AS, Dolci M, Zbinden-Trichet C, Bossou R, Meyrat BJ, Hohlfeld J. Success and failure for children born with facial clefts in Africa: a 15-year follow-up. World J Surg 2012; 36 (08) 1963-1969
  • 15 Gross RE. A new method for surgical treatment of large omphaloceles. Surgery 1948; 24 (02) 277-292
  • 16 Minkes RK, Oldham KT, Colombani PM. , et al. Abdominal wall defects. In: Principles and Practice of Pediatric Surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2005: 1103-1119
  • 17 Schuster SR. A new method for the staged repair of large omphaloceles. Surg Gynecol Obstet 1967; 125 (04) 837-850
  • 18 Geissler GH. Abdominal wall defects. Arensman RM, Bambini DA, Almond PS. Pediatric Surgery. Georgetown, TX: Landes Bioscience; 2000: 361-365
  • 19 Pereira RM, Tatsuo ES, Simões e Silva AC. , et al. New method of surgical delayed closure of giant omphaloceles: Lazaro da Silva's technique. J Pediatr Surg 2004; 39 (07) 1111-1115
  • 20 Mitanchez D, Walter-Nicolet E, Humblot A, Rousseau V, Revillon Y, Hubert P. Neonatal care in patients with giant ompholocele: arduous management but favorable outcomes. J Pediatr Surg 2010; 45 (08) 1727-1733
  • 21 Barlow B, Cooper A, Gandhi R, Niemirska M. External silo reduction of the unruptured giant omphalocele. J Pediatr Surg 1987; 22 (01) 75-76
  • 22 Tran DA, Truong QD, Nguyen MT. Topical application of povidone-iodine solution (Betadine) in the management of giant omphaloceles. Dermatology 2006; 212 (Suppl. 01) 88-90
  • 23 Hatch Jr EI, Baxter R. Surgical options in the management of large omphaloceles. Am J Surg 1987; 153 (05) 449-452
  • 24 van Eijck FC, Aronson DA, Hoogeveen YL, Wijnen RM. Past and current surgical treatment of giant omphalocele: outcome of a questionnaire sent to authors. J Pediatr Surg 2011; 46 (03) 482-488