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      Repair of Ruptured Omphalocele Sac in the Neonatal Period and Beyond

      case-report

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          Abstract

          Conservative management of giant omphalocele in the neonate period is a known strategy to allow tissue growth aiding in anatomical closure. However, rupture of the covering sac is considered an absolute contraindication for continuing conservative management. We report a case where a ruptured sac of giant omphalocele was ingeniously sutured to restore its integrity, and conservative management continued. The giant omphalocele later became a huge ventral hernia and was gradually reduced and primary closure was achieved with multiple surgeries over a period of 4 years.

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          Evaluation of conservative therapy for exomphalos.

          M Corbally, Stephen A. Adam, R. Fitzgerald (1991)
          Two management patterns were identified in 36 patients with exomphalos--primary surgical closure and initial topical therapy with delayed surgical closure. Primary surgical closure of minor exomphalos was well tolerated in 15 patients, but was associated with a high local and systemic morbidity rate in 14 patients with major defects. In contrast, initial topical therapy with silver sulphadiazine and delayed closure in seven matched patients with a major defect were well tolerated and did not prolong duration of hospitalization. Enteral feeding was more readily established and subsequent fascial closure facilitated in the conservatively treated group. It was suggested that this method should be more often considered in the management of all instances of major exomphalos.
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            Conservative management of giant omphalocele with topical povidone-iodine and its effect on thyroid function

            Jill Whitehouse, David Gourlay, Abbey R. Masonbrink … (2010)
            The aim of the study was to evaluate topical povidone-iodine as a bridge to delayed fascial closure of giant omphaloceles with emphasis on its effect on thyroid function.
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              Topical Application of Povidone-Iodine Solution (Betadine ® ) in the Management of Giant Omphaloceles

              Dong A Tran, Quang Truong, Minh Nguyen (2006)
              Giant omphaloceles, especially if they contain liver tissue, remain the greatest challenge to pediatric surgeons for the coverage of the huge defect. Various reconstructive techniques have been described in the literature, each with advantages and disadvantages. Standard treatment has been placement of a Silastic silo to allow gradual return of abdominal organs to the abdomen with its limited space. The worst complication of silo placement is infection of the fascia with disruption of the suture line. When fascial infection occurs, closure of the abdominal wall is very difficult or impossible. In this report, the authors describe their experience in treating 5 patients with giant omphaloceles, between 1999 and 2003, utilizing an abs orbable synthetic mesh (polyglactin 910-Vicryl) for abdominal closure and topical application of povidone-iodine 10/100 solution (Betadine ® ) to prevent infection. All patients had perfect results with the simple postoperative care, early oral feeding and were discharged after 2 months of hospitalization with complete skin coverage.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Indian Assoc Pediatr Surg
                Journal ID (iso-abbrev): J Indian Assoc Pediatr Surg
                Journal ID (publisher-id): JIAPS
                Title: Journal of Indian Association of Pediatric Surgeons
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0971-9261
                ISSN (Electronic): 1998-3891
                Publication date (Print): Jan-Feb 2020
                Publication date (Electronic): 27 November 2019
                Volume: 25
                Issue: 1
                Pages: 46-48
                Affiliations
                [1]Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
                [1 ]Department of Pediatric Surgery, Gauhati Medical College, Guwahati, Assam, India
                Author notes
                Address for correspondence: Prof. Veereshwar Bhatnagar, Room No. 4002, Department of Pediatric Surgery, Teaching Block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail: veereshwarb@ 123456hotmail.com
                Article
                Publisher ID: JIAPS-25-46
                DOI: 10.4103/jiaps.JIAPS_195_18
                PMC ID: 6910046
                PubMed ID: 31896900
                SO-VID: 6dd1fd5c-7709-4634-a024-a570e4a21cfb
                Copyright © Copyright: © 2019 Journal of Indian Association of Pediatric Surgeons
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 19 September 2018
                Date revision received : 11 January 2019
                Date accepted : 16 February 2019
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: exomphalos,omphalocele,silo,tissue expanders,ventral hernia
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: exomphalos, omphalocele, silo, tissue expanders, ventral hernia

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