Chen Feng,Fu Zhong,Fang Tao,et al.Ruptured Omphalocele with prolapsed-intestinal volvulus with incarcerated necrosis and ileal atresia: a case report and literature review[J].Journal of Clinical Pediatric Surgery,,21():179-185.[doi:10.3760/cma.j.cn.101785-202012030-015]
Ruptured Omphalocele with prolapsed-intestinal volvulus with incarcerated necrosis and ileal atresia: a case report and literature review
- Keywords:
- Hernia; Umbilical/SU; Intestinal Atresia/SU
- Abstract:
- Objective To explore the experience of diagnosis and treatment of Ruptured Omphalocele(RO) in order to improve the level of diagnosis and treatment of the disease by pediatric surgeons.Methods The clinical data of a 38-week-term infant with RO were retrospectively analyzed.The databases of Pubmed, Springer Link, Google Scholar, CBM, CNKI, Wanfang and CQVIP were searched for the relevant publications using such key words as omphalocele and ruptured.Also a systematic review of literatures was performed.Results The 19 cases enrolled included 11 giant RO and 8 small RO.The maximum area of abdominal wall defect is 10 cm×10cm.Concurrent conditions included intestinal atresia(n=3), intestinal volvulus(n=2), intestinal atresia with volvulus(n=1), intestinal malrotation(n=2), pulmonary dysplasia with or without pulmonary hypertension(n=5), parasitic fetus and cryptorchid(n=1), Edwards syndrome and bilateral radius dysplasia(n=1), Turner syndrome(n=1).All 8 small RO underwent phase I repair.Among the 11 cases of giant RO, 2 cases underwent phase I repair directly, and 1 case of giant RO underwent phase I repair using parasitic fetal skin.1 case of capsular suture, external drug coating and abdominal wall hernia repair, 8 routine Silo bag with or without reticular patch delayed closure.1 case of short bowel syndrome due to whole midgut resection needs long-term nutrition treatment and waiting for intestinal transplantation, 1 case of flap necrosis after stage Ⅰ repair, 3 cases of adhesive intestinal obstruction caused by repeated abdominal infection, and 1 case of refractory diarrhea after operation.With the exception of 1 patient of termination of pregnancy and 2 patients of postoperative death, the other children did not have have severe respiratory and circulatory disturbance after the operation and all survived.Conclusion RO often complicated with serious abnormalities, which directly affect the prognosis.We should attach importance to prenatal diagnosis.Relevant chromosome examination and a good job of perinatal evaluation is needed.Vaginal delivery should be choosed carefully.Giant RO is recommended to choose cesarean section.Try utmost to protect the organs outside the body.Surgery should be done immediately after birth.Phase I repair can be selected for small RO and delayed repair is a more safe and effective method for giant RO.
References:
[1] Gonzalez KW,Chandler NM.Ruptured omphalocele:Diagnosis and management[J].Semin Pediatr Surg,2019,28(2):101-105.DOI:10.1053/j.sempedsurg.2019.04.009.
[2] Mammadov E.Patent Omphalomesenteric Duct with Protruding Bowels through a Ruptured Omphalocele[J].Balkan Med J,2018,35(1):118-119.DOI:10.4274/balkanmedj.2017.0230.
[3] Dar SH,Liaqat N,Iqbal J,et al.An epigastric heteropagus twin with ruptured giant omphalocele[J].J Neonatal Surg,2014,3(2):23.
[4] Betat Rda S,Telles JA,Gobatto AM,et al.Ruptured omphalocele mimicking gastroschisis in a fetus with edwards syndrome[J].Am J Med Genet A,2014,164A(2):559-560.DOI:10.1002/ajmg.a.36289.
[5] Moon SB,Jung SE,Park KW.Ruptured fetal omphalocele complicated by midgut volvulus with strangulation[J].J Pediatr Surg,2009,44(1):303-304.DOI:10.1016/j.jpedsurg.2008.10.029.
[6] Yamagishi J,Ishimaru Y,Takayasu H,et al.Visceral coverage with absorbable mesh followed by split-thickness skin graft in the treatment of ruptured giant omphalocele[J].Pediatric Surgery International,2007,23(2):199-201.DOI:10.1007/s00383-006-1820-7.
[7] Chen C.Ruptured omphalocele with extracorporeal intestines mimicking gastroschisis in a fetus with Turner syndrome[J].Prenatal Diagnosis,2007,27(11):1067-1068.DOI:10.1002/pd.1823.
[8] Osama AB,Andrew W,David LS,et al.Absorbable Mesh and Skin Flaps or Grafts in the Management of Ruptured Giant Omphalocele[J].J Pediatr Surg,2003,38:725-728.DOI:10.1016/jpsu.2003.50193.
[9] 王继之,张景洲,徐维清.脐膨出产前囊膜破裂内脏脱出1例报告[J].航空航天医药,1996,7(2):110.DOI:CNKI:SUN:HKHT.0.1996-02-029. Wang JZ,Zhang JZ,Xu WQ.Prenatal Ruptured Omphalocele with splanchnocele:a case report[J].Aerospace Medicine,1996,7(2):110.DOI:CNKI:SUN:HKHT.0.1996-02-029.
[10] el-Shafie M,Waag KL,Spitz L.Ileal atresia secondary to antenatal strangulation by a ruptured omphalocele[J].J Pediatr Surg,1972,7(1):64-65.DOI:10.1016/0022-3468(72)90407-1.
[11] Filler RM,Eraklis AJ,Das JB,et al.Total intravenous nutrition.An adjunct to the management of infants with a ruptured omphalocele[J].Am J Surg,1971,121(4):454-459.DOI:10.1016/0002-9610(71)90239-x.
[12] Gregory G,Christopher F.Ruptured Omphalocele[J].Clinical Pediatrics,1969,8(7):409-410.DOI:10.1177/000992286900800714.
[13] Geiger PE.Prenatally ruptured omphalocele[J].Am J Surg,1968,116(6):909.DOI:10.1016/0002-9610(68)90464-9.
[14] Fox Pf,Brennan Je.Ruptured omphalocele and jejunal atresia[J].Ann Surg,1951,133(1):123-126.DOI:10.1097/00000658-195101000-00013.
[15] 钭金法.新生儿巨型脐膨出的治疗策略[J].临床小儿外科杂志,2020,19(4):292-296.DOI:10.3969/j.issn.1671-6353.2020.04.002. Tou JF.Treatment strategy for neonatal giant omphalocele[J].J Clin Ped Sur,2020,19(4):292-296.DOI:10.3969/j.issn.1671-6353.2020.04.002.
[16] Verla MA,Style CC,Olutoye OO.Prenatal diagnosis and management of omphalocele[J].Seminars in Pediatric Surgery,2019,28(2):84-88.DOI:10.1053/j.sempedsurg.2019.04.007.
[17] Lakasing L,Cicero S,Davenport M,et al.Current outcome of antenatally diagnosed exomphalos:an 11 year review[J].Journal of Pediatric Surgery,2006,41(8):1403-1406.DOI:10.1016/j.jpedsurg.2006.04.015.
[18] Calvert N,Damiani S,Sunario J,et al.The outcomes of pregnancies following a prenatal diagnosis of fetal exomphalos in Western Australia[J].Aust N Z J Obstet Gynaecol,2009,49(4):371-375.DOI:10.1111/j.1479-828X.2009.01036.x.
[19] Ionescu S,Mocanu M,Andrei B,et al.Differential diagnosis of abdominal wall defects-omphalocele versus gastroschisis[J].Chirurgia (Bucur),2014,109(1):7-14.
[20] Saxena AK,Raicevic M.Predictors of mortality in neonates with giant omphaloceles[J].Minerva pediatrica,2018,70(3):289-295.DOI:10.23736/S0026-4946.17.05109-X.
[21] Kelly KB,Ponsky TA.Pediatric Abdominal Wall Defects[J].Surg Clin North Am,2013,93(5):1255-1267.DOI:10.1016/j.suc.2013.06.016.
[22] Roux N,Jakubowicz D,Salomon L,et al.Early surgical management for giant omphalocele:Results and prognostic factors[J].J Pediatr Surg,2018,53(10):1908-1913.DOI:10.1016/j.jpedsurg.2018.04.036.
[23] Travassos DV,van Eerde AM,Kramer WL.Management of a Giant Omphalocele with Non-Cross-Linked Intact Porcine-Derived Acellular Dermal Matrix (Strattice) Combined with Vacuum Therapy[J].European J Pediatr Surg Rep,2016,3(2):61-63.DOI:10.1055/s-0035-1549364.
[24] Tarcǎ E,Aprodu S.Past and present in omphalocele treatment in Romania[J].Chirurgia (Bucur),2014,109(4):507-513.
[25] Peters NC,Hooft ME,Ursem NT,et al.The relation between viscero-abdominal disproportion and type of omphalocele closure[J].Eur J Obstet Gynecol Reprod Biol,2014,181:294-299.DOI:10.1016/j.ejogrb.2014.08.009.
[26] Bauman B,Stephens D,Gershone H,et al.Management of giant omphaloceles-a systematic review of methods of staged surgical vs nonoperative delayed closure[J].J Pediatr Surg,2016,51:1725-1730.DOI:10.1016/j.jpedsurg.2016.07.006.
[27] Bode CO,Ademuyiwa AO,Elebute OA.Formal saline versus honey as escharotic in the conservative management of major omphaloceles[J].Niger Postgrad Med J,2018,25(1):48-51.DOI:10.4103/npmj.npmj_159_17.
[28] Jiang WW,Xu XQ,Geng QM,et al.Enteroenteroanastomosis near adjacent ileocecal valve in infants[J].World J Gastroenterol,2012,18(48):7314-7318.DOI:10.3748/wjg.v18.i48.7314.
[29] Levy S,Tsao K,Cox CSJ,et al.Component separation for complex congenital abdominal wall defects:not just for adults anymore[J].J Pediatr Surg,2013,48(12):2525-2529.DOI:10.1016/j.jpedsurg.2013.05.067.
[30] Zmora O,Castle SL,Papillon S,et al.The biological prosthesis is a viable option for abdominal wall reconstruction in pediatric high risk defects[J].Am J Surg,2017,214(3):479-482.DOI:10.1016/j.amjsurg.2017.01.004.
Memo
收稿日期:2020-12-10。
基金项目:赣州市指导性科技计划项目（2020GZ2020ZSF045）
通讯作者:刘潜,Email:liuqiangmu2017@126.com