Experience with Exomphalos in a Tertiary Health Center in Nigeria

Abstract

There is paucity of data on the pattern, presentation and outcome ofmanagement of exomphalos in developing countries. Aretrospective study of all cases of
exomphalos managed within a at the Obafemi Awolowo University Teaching hospital, Ile Ife,
SouthwesternNigeria. Ninety-one cases of exomphalos were managed over the study period. Forty-six (50.5%) were males and 45 (49.5%) were females (M:F=1:1). The mean age at presentation was 2.48days (range 2hours - 15 days). The median weight was 3.0kg (range 1.6 - 4.95kg). Sixty four (7.3%) patients had major exomphalos (defect > 5cm) while
27 (29.7%) were minor (defect <5cm). The size of the defects ranged from3cmto 16cm(median 8cm).Associated anomalies were present in 40(44%) patients. Fifty-five
(60.4%) patients were managed non-operatively while 36 (39.6%) had emergency surgical closure. Over two-thirds (66%) of the patients managed nonoperatively survived compared to 47.2% in the surgical group, but thiswas not statistically significant (p=0.231).The
mortality rate among those with ruptured exomphalos was 75%. The overall mortality rate was 45 %( 41 of 91). Sepsis was the most common cause of death while respiratory distresswas common among thosewho had surgical closure. The average duration of hospitalization in the nonoperative group was 34 days (range 18-82 days) and 16
days in those who survived surgical repair (range 4-28 days).
For the less developed countries a nonoperative approach is advocated in the management of omphalocele because mortality from emergency operative closure is very high.

Keywords: Exomphalos, Management, Outcome, Developing country

African Journal of Paediatric Surgery Vol. 4 (2) 2007: pp. 56-60