Ruptured omphalocele with ischemic bowels
Journal
Pediatrics and neonatology
Date Issued
2022-03-24
Abstract
A term male newborn was diagnosed with omphalocele prenatally by ultrasound, revealing a bowel herniation covered with membrane (Fig. 1). Due to decreased fetal heartbeat, an emergent cesarean section was performed. Preoperative sonography showed bowel herniation without membrane. After delivery, we observed a direct exposure of bowels with ruptured membrane as well as the insertion of the umbilical cord to the apex of the membrane. The bowels became dark red with ischemic change (Fig. 2). A large amount of bloody gastric aspirate was drawn using an orogastric tube. This was accompanied with hypotension and pallor. During the surgery, a protrusion of small intestine, ascending and transverse colon through a 2-cm sized abdominal defect with a perforated whitish membrane at the umbilical area were found. There was an adhesion band at the edge of the defect. Total bowel reduction and closure of the defect were performed smoothly. After the surgery, abdominal distention regressed and bowel movement improved gradually. No other congenital or chromosomal anomalies were identified. The patient was discharged under stable conditions. Omphalocele is a congenital abdominal wall defect, wherein a membrane covers the protruded viscera. The defect occurs at the umbilical ring with an insertion of the umbilical vessels into the membrane.1Ledbetter D.J. Gastroschisis and omphalocele.Surg Clin North Am. 2006; 86 (vii): 249-260Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar The rupture rate of omphalocele has been estimated to be 7%–15%.2Gonzalez K.W. Chandler N.M. Ruptured omphalocele: diagnosis and management.Semin Pediatr Surg. 2019; 28: 101-105Crossref PubMed Scopus (14) Google Scholar It is necessary to distinguish a ruptured omphalocele from gastroschisis, wherein umbilical vessels are inserted to the umbilicus.1Ledbetter D.J. Gastroschisis and omphalocele.Surg Clin North Am. 2006; 86 (vii): 249-260Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar Patients with omphalocele have a higher occurrence of associated anomalies, such as chromosomal abnormalities, cardiac defects, and genitourinary anomalies.2Gonzalez K.W. Chandler N.M. Ruptured omphalocele: diagnosis and management.Semin Pediatr Surg. 2019; 28: 101-105Crossref PubMed Scopus (14) Google Scholar Existing surgical treatments include primary, staged, and delayed repair. Primary surgical closure is the treatment of choice.3Rogdo B. Mack A.J. Giant omphalocele: current perspectives.Res Rep Neonatol. 2016; 6: 33-39Google Scholar There is no preferred method between staged and delayed repair in current studies.2Gonzalez K.W. Chandler N.M. Ruptured omphalocele: diagnosis and management.Semin Pediatr Surg. 2019; 28: 101-105Crossref PubMed Scopus (14) Google Scholar,3Rogdo B. Mack A.J. Giant omphalocele: current perspectives.Res Rep Neonatol. 2016; 6: 33-39Google Scholar In the case of this newborn, the exposed ischemic bowels after birth were caused either by the fetal distress or by the adhesion band leading to vascular compromise of the ruptured omphalocele. Fetal distress and ischemic bowels have bidirectional cause-to-effect relationship. When a fetus with prenatally diagnosed omphalocele presents with fetal distress, membrane rupture with intestinal vascular compromise should be considered as an indication for an emergent cesarean delivery as well as surgical intervention for repair. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
SDGs
Type
journal article