Description and early clinical outcome of patients with omphalocele admitted to a tertiary hospital in Kigali, Rwanda over a three-year period ­ a cross-sectional study

BACKGROUND: Studies suggest that patients with omphalocele have poor outcomes which are associated with the high rate of associated congenital abnormalities. A variety of surgical management techniques have been described, with some requiring equipment not available in resource-limited countries. OBJECTIVES: This study aimed to describe associated abnormalities, management and early hospital outcomes of patients with omphalocele.METHODS: A retrospective study of newborns diagnosed with omphalocele hospitalized from January 2014 to December 2016 at a tertiary level facility, the University Hospital of Kigali (CHUK) in Kigali, Rwanda. Case-file review of included newborns and analysis of the data collected was performed with SPSS version 16.0. RESULTS: Thirty-one patients were hospitalized with omphalocele during the three-year study period. A limited number of investigations were done to diagnose possible associated congenital abnormalities. Three patients (9.7%) were found to have cardiac abnormalities, nine (27.0%) had suspected genetic abnormalities including Trisomy 13, 18 and Beckwith Wiedemann Syndrome. In terms of management, ten patients (32.3%) underwent primary closure. Sixteen patients (51.6%) developed sepsis during hospitalization. Of the thirty-one patients hospitalized, nine (27.0%) died in the hospital. The only factor found to be associated with increased mortality was the size of the omphalocele, with small omphaloceles associated with lower mortality than large omphaloceles (OR 0.909, P-value 0.028).CONCLUSION: Mortality of these patients is significant and slightly higher in patients with larger omphalocele. Newborns with omphalocele should receive appropriate investigations to diagnose associated congenital abnormalities and have early recognition and prompt management of complications, especially sepsis. The results are limited by the small sample size and limited investigations performed to detect associated abnormalities

Hernie ombilicale de l'enfant : aspects epidemiologiques; cliniques et therapeutiques au complexe pediatrique de Bangui (RCA)

Les objectifs de ce travail sont de decrire les aspects epidemiologiques; cliniques et therapeutiques de la hernie ombilicale. A cet effet; une etude retrospective a ete conduite de juin 2005 a juin 2010 sur 93 cas de hernie ombilicale. Celle-ci representait 12 de toutes les interventions chirurgicales; 33;7 des hernies de l'enfant et 5;2 des cas d'hospitalisation. La population etait masculine avec un sex-ratio de 2;2. L'age moyen etait de 2;3 ans avec des extremes d'un mois et 15 ans. La tranche d'age la plus touchee etait celle des enfants de moins d'un an. Les malades se plaignaient dans 51;3 de douleurs abdominales. L'etranglement etait la complication la plus representee avec 22;6 de cas. 11 engouements etaient observes soit 11;8. Les hernies ombilicales dont le diametre etait superieur a 2 cm etaient les plus representees (57). Le paludisme et la typhoide etaient les principales pathologies associees. La hernie ombilicale; pathologie frequente en pratique pediatrique africaine; a ete rapportee dans la litterature comme nous; et le sexe masculin semble etre un facteur de risque. C'est une affection non douloureuse en general et notre fort taux de douleur pourrait etre lie aux formes compliquees ou pathologies medicales associees. Le traitement chirurgical etait notre seul mode de traitement. Les etranglements herniaires; les engouements et les hernies ombilicales simples persistantes etaient systematiquement operes. Les dernieres categories devraient desormais faire l'objet d'un examen approfondi car une hernie ombilicale simple; souvent associee a une douleur ou autres signes peut cacher une pathologie medicale ou chirurgicale