Omphalocoele and gastroschisis: management in a developing country

Background: The management of omphalocoele and gastroschisis presents a lot of challenges. While most of these challenges have largely been overcome in developed countries, the same cannot be said of the developing countries. Methods: The medical records of neonates with omphalocoele and gastroschisis seen at Jos University Teaching Hospital between January 1991 and December 2001 were retrospectively reviewed. Results: There were 42 neonates with omphalocoele and 12 with gastroschisis. The median age at presentation of neonates with omphalocoele with intact sac was 72 hours (range 1-5 days) while the median age for those with ruptured sac was 14 hours (range: 3-36 hrs). The median age at presentation of neonates with gastroschisis was 10 hours (range: 2-40 hrs.) Six neonates with ruptured omphalocoele and 4 with gastroschisis had gangrenous bowel at presentation. Eighteen neonates with omphalocoele had associated congenital anomalies, mostly involving the gastrointestinal and genitourinary systems. No neonate with gastroschisis had associated congenital anomaly. Sixteen neonates with omphalocoele were managed non-operatively, while 26 had operative treatment at initial presentation. Of these, 14 had primary fascial closure, 8 had skin closure, and 4 had improvised silo. All neonates with gastroschisis had primary fascial closure at presentation. A total of 22 neonates died: eighteen omphalocoele (11 of them managed surgically) and 4 gastroschisis. Conclusion: The management of neonates with omphalocoele and gastroschisis continues to pose challenges in our environment, with high mortality rate. Health education, provision of neonatal intensive care facilities, availability of total parenteral nutrition in ours, and similar environment may improve the survival rate of this group of patients. (Nig J Surg Res 2003; 5: 57 - 61) Key words: Omphalocoele, gastroschisis, developing countrie