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

Abdominal Wall Reconstruction Using De-Epithelialized Dermal Flap: A New Technique

Background: Although autogenous materials have been used in abdominal wall hernioplasty for a long time; the introduction of prosthetic materials diminished their popularity. However; these materials may be expensive; inappropriate or unavailable. The aim of this study is to determine the place of de-epithelialized dermal flap in the reconstruction of abdominal wall hernias. Materials and Methods: A five-year prospective; descriptive analysis of eligible patients with difficult abdominal wall hernias closed with de-epithelialized dermal flap in a Nigerian Tertiary Health Institution; from January 2001 to December 2005. Results: Over the five-year period; 37 patients were recruited into the study. There were 11 males and 26 females; giving a male: female ratio of 1: 2.4. The ages ranged from 8 months to 47 years (mean = 12.6 years). The defects consisted of 15 incisional hernias; 12 intermuscular/inferior lumbar hernias; nine healed exomphalos major and two giant umbilical hernias. The size of the hernia defects ranged from 4.5 cm to13cm (mean = 6.4 cm). Three patients had bowel resection and end-to-end anastomosis; in addition to the flap reconstruction. Morbidity was minimal and included skin dimpling in 11 patients; seroma in three; and wound infection in two patients. Neither recurrence of herniation nor mortality was recorded during the period of follow-up; which ranged from three months to 4.5 years (mean = nine months). Conclusion: The results suggest that this is a useful technique that can easily be applied in many centers with minimal resources. It is cheap; effective and associated with minimal morbidity

Prune belly syndrome a rare case report

A case of a rare congenital anomaly of Prune Belly Syndrome (PBS) predominant in males is presented. 1 Incidence is 1 in 40;000 lives births. The complete syndrome is characterized by ; dilatation of the upper urinary tract; lateral deviation of the dilated ureters large bladder with urachal anomalies; vesicoureteral reflux; dilatation of the prostatic utricle; undescended testis and patchy agenesis of the anterior 2 abdominal wall. All the above features may not necessarily be present in one single case. The major anomaly is due to failure of proper development of both the urinary tract and anterior abdominal wall. Respiratory; cardiac; skeletal and anorectal malformations may be present as well

Influence des fils de suture sur les infections post-operatoires de la paroi abdominale

Repartis en deux groupes; 145 malades ont ete operes de chirurgie abdominale dans les memes conditions d'asepsie et suivis pendant 6 mois. Dans le premier groupe comprenant 75 malades; le plan musculo-aponevrotique etait suture aux fils synthetiques a resorption lente et il y aeu 6;6 pour cent d'infections parietales. Parmi les 70 malades du second groupe sutures avec des fils non resorbables; il ya eu 18;5 pour cent d'infections parietales. La difference etait significative; ce qui permet de recommander l'utilisation des flis synthetiques a resorption lente dans la fermeture de paroi abdominale en zone tropicale ou les conditions d'asepsie parfaite sont difficiles a reunir