Challenges and outcomes of management of anterior abdominal wall defects in a Nigerian tertiary hospital

Afr J Paediatr Surg. May-Aug 2011;8(2):159-63. doi: 10.4103/0189-6725.86053.

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.

Publication types

  • Comparative Study

MeSH terms

  • Abdominal Wall / surgery*
  • Adolescent
  • Adult
  • Female
  • Follow-Up Studies
  • Gastroschisis / diagnosis
  • Gastroschisis / surgery*
  • Gestational Age
  • Hernia, Umbilical / diagnosis
  • Hernia, Umbilical / surgery*
  • Humans
  • Infant, Newborn
  • Male
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Surgical Wound Dehiscence / surgery*
  • Treatment Outcome
  • Young Adult