Nonsurgical (Conservative) Treatment of Giant Omphalocele

Abstract

Between January 1970 and December 1984, 65 patients with a congenital anterior abdominal wall defect were admitted to the Pediatric Surgical Center of the St. Radboud Hospital, Nijmegen, The Netherlands. There were 39 cases of omphalocele. Ten had giant omphalocele, defined as omphalocele that could not be closed primarily. In these cases, a conservative method of treatment was used.

The results are reported of these 10 cases of giant omphalocele with special emphasis on mortality, complications, and length of hospital stay. Mean hospital stay was 95 days. Local infection did not present serious problems. Sepsis occurred in half the patients but was managed with antibiotics. There was one case of late volvulus of the stomach.

All local applications, if used regularly, gave rise to complications. Two cases of hypothyroidism caused by the application of povidon-iodine and one case of alcohol intoxication were observed. In early years, one child was lost due to mercury poisoning. There was one early and one late death unrelated to the procedure.

Get full access to this article

View all access options for this article.

References

Ahlfeld F. Alcohol bei der Behandlung inoperabeler Bauchbrüchen. Monatschr. Geburtshilfe, Gynäkol. 1899;10:124.

Grob M. Lehrbuch der Kinderchirurgie. Stuttgart: Thieme 1957;311-5.

Grob M. Conservative treatment of exomphalos. Arch Dis Child 1963;38:148-50.

Schuster SR Omphalocele, hernia of the umbilical cord and gastroschisis. In: Ravitch MM , et al. (eds). Pediatric surgery . Chicago: Year Book Med Publ 1979;778-801.

Holder TM , Ashcraft KW Omphalocele and gastroschisis. In: Pediatric surgery . Philadelphia: W. B. Saunders , 1980 ; p 579.

Slim MS Combined treatment of omphalocele. Surgery 1967;61:314-7.

Ein SH , Shandling B. A new nonoperative treatment of large omphalocele with a polymer membrane . J Pediatr Surg 1978;13:255-7.

Knight PJ , Buckner D. , Vassy LE Omphalocele: treatment options. Surgery 1981 ;89:332-6.

Campbell FJ , Campbell JR , Harrison MW Selective management of omphalocele. Am J Surg 1982;143:572-4.

10.

Gilbert MG , et al. Staged surgical repair of large omphaloceles and gastroschisis . J Ped Surg 1968;3:702-9.

11.

Gierup J. , Olsen L. , Lundkvist K. Aspects in the treatment of omphalocele and gastroschisis. Twenty years of clinical experience. Z Kinderchir 1982;35:3-6.

12.

Mahour GH , Wietzman JJ , Rosenkrantz JC Omphalocele and gastroschisis. Am Surg 1973 ;177:478-82.

13.

Towne BH , Peters G. , Chang Jhf. The problem of "giant" omphalocele. J Ped Surg 1980;15:543-8.

14.

Stone HH Immediate permanent fascial prothesis for gastroschisis and massive omphaloceles . Surg Gynecol Obstet 1981;153:221-4.

15.

Bax Nma , Mud HJ , Noordijk JA , et al. A plea for conservative treatment of large unruptured omphaloceles . Z Kinderch 1984;39:102-5.

16.

Stanley-Brown EG , Frank JE Mercury poisoning from application to omphalocele . JAMA 1971 ;216:2144-5.

17.

Seashore JH , MacNaughton RJ , Falbert JL Treatment of gastroschisis and omphalocele with biological dressings. J Pediatr Surg 1975;10:9-17.

18.

Heule A. , Adriaenssens K. , De Hauvere R. , et al. Omphalocele and mercury intoxication. Z Kinderch 1976;18:420-3.

19.

Firor HV Omphalocele: an appraisal of therapeutic approaches. Surgery 1971;69:208-14.

20.

Venupogal S. , Zachary RB , Spitz L. Exomphalos and gastroschis, a 10-year review . Br J Surg 1976;63:523-5.

21.

Cantrell JR , Haller JA , Ravitch MM A syndrome of congenital defects involving the abdominal wall, sternum, diaphragm, pericardium, & heart. Surg Gynecol Obstet 1958;107:602.