Download PDF
CC BY 4.0 · European J Pediatr Surg Rep. 2020; 08(01): e112-e116
DOI: 10.1055/s-0040-1721054
Case Report

Treatment of Ruptured Giant Omphalocele and Gastroschisis with Liver Herniation using a Wound Retractor as a Novel Approach

Jana Nelson
1   Division of Pediatric Surgery, Leipzig University Hospital for Children and Adolescents, Leipzig, Saxony, Germany
,
Robin Wachowiak
1   Division of Pediatric Surgery, Leipzig University Hospital for Children and Adolescents, Leipzig, Saxony, Germany
,
Manuela Siekmeyer
2   Department of Pediatric Medicine, Leipzig University Hospital for Children and Adolescents, Leipzig, Saxony, Germany
,
Matthias Knuepfer
2   Department of Pediatric Medicine, Leipzig University Hospital for Children and Adolescents, Leipzig, Saxony, Germany
,
Ulrich Thome
2   Department of Pediatric Medicine, Leipzig University Hospital for Children and Adolescents, Leipzig, Saxony, Germany
,
Stepan Holger
3   Division of Obstetrics and Gynaecology, University Hospital Leipzig Department of Obstetrics and Gynaecology, Leipzig, Saxony, Germany
,
Martin Lacher
1   Division of Pediatric Surgery, Leipzig University Hospital for Children and Adolescents, Leipzig, Saxony, Germany
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Ruptured giant omphaloceles (GO) and gastroschisis with total liver herniation are rare cases of exceptionally large abdominal wall defects. Many of these children have lethal outcome. The surgical and postsurgical management are complex. We report on two cases treated with staged surgical repair using a wound retractor as a silo. With this technique, the liver and intestines could be reduced into the abdomen with secondary closure of the abdominal cavity within the first 1 to 2 weeks of life.

Keywords

ruptured giant omphalocele - giant gastroschisis - liver herniation - abdominal wall defects - staged surgical repair


Publication History

Received: 31 July 2020

Accepted: 20 August 2020

Article published online:
15 December 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Campos BA, Tatsuo ES, Miranda ME. Omphalocele: how big does it have to be a giant one?. J Pediatr Surg 2009; 44 (07) 1474-1475 , author reply 1475
    CrossrefPubMedGoogle Scholar
  • 2 Roux N, Jakubowicz D, Salomon L. et al. Early surgical management for giant omphalocele: results and prognostic factors. J Pediatr Surg 2018; 53 (10) 1908-1913
    CrossrefPubMedGoogle Scholar
  • 3 Akinkuotu AC, Sheikh F, Olutoye OO. et al. Giant omphaloceles: surgical management and perinatal outcomes. J Surg Res 2015; 198 (02) 388-392
    CrossrefPubMedGoogle Scholar
  • 4 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 Pediatr Surg 2016; 51 (10) 1725-1730
    CrossrefPubMedGoogle Scholar
  • 5 Mack AJ, Rofdo B. Giant omphalocele: current perspectives. Res Rep Neonatol 2016; 6: 33-39
    PubMedGoogle Scholar
  • 6 Saxena AK, Raicevic M. Predictors of mortality in neonates with giant omphaloceles. Minerva Pediatr 2018; 70 (03) 289-295
    CrossrefPubMedGoogle Scholar
  • 7 McClellan EB, Shew SB, Lee SS, Dunn JCY, Deugarte DA. Liver herniation in gastroschisis: incidence and prognosis. J Pediatr Surg 2011; 46 (11) 2115-2118
    CrossrefPubMedGoogle Scholar
  • 8 Panitch HB. Pulmonary complications of abdominal wall defects. Paediatr Respir Rev 2015; 16 (01) 11-17
    PubMedGoogle Scholar
  • 9 Svetanoff WJ, Zendejas B, Demehri FR, Cuenca A, Nath B, Smithers CJ. Giant gastroschisis with complete liver herniation: a case report of two patients. Case Rep Surg 2019; 2019: 4136214
    PubMedGoogle Scholar
  • 10 Gonzalez KW, Chandler NM. Ruptured omphalocele: diagnosis and management. Semin Pediatr Surg 2019; 28 (02) 101-105
    CrossrefPubMedGoogle Scholar
  • 11 Gross RE. A new method for surgical treatment of large omphaloceles. Surgery 1948; 24 (02) 277-292
    PubMedGoogle Scholar
  • 12 Schuster SR. A new method for the staged repair of large omphaloceles. Surg Gynecol Obstet 1967; 125 (04) 837-850
    PubMedGoogle Scholar
  • 13 Allen RG, Wrenn Jr EL. Silon as a sac in the treatment of omphalocele and gastroschisis. J Pediatr Surg 1969; 4 (01) 3-8
    CrossrefPubMedGoogle Scholar
  • 14 Risby K, Jakobsen MS, Qvist N. Congenital abdominal wall defects: staged closure by dual mesh. J Neonatal Surg 2016; 5 (01) 2
    CrossrefPubMedGoogle Scholar
  • 15 Foglia R, Kane A, Becker D, Asz-Sigall J, Mychaliska G. Management of giant omphalocele with rapid creation of abdominal domain. J Pediatr Surg 2006; 41 (04) 704-709 , discussion 704–709
    CrossrefPubMedGoogle Scholar
  • 16 Martin AE, Khan A, Kim DS, Muratore CS, Luks FI. The use of intraabdominal tissue expanders as a primary strategy for closure of giant omphaloceles. J Pediatr Surg 2009; 44 (01) 178-182
    CrossrefPubMedGoogle Scholar
  • 17 Sugandhi N, Saha M, Bhatnagar V, Dhua AK. Repair of ruptured omphalocele sac in the neonatal period and beyond. J Indian Assoc Pediatr Surg 2020; 25 (01) 46-48
    CrossrefPubMedGoogle Scholar
  • 18 Aldridge B, Ladd AP, Kepple J, Wingle T, Ring C, Kokoska ER. Negative pressure wound therapy for initial management of giant omphalocele. Am J Surg 2016; 211 (03) 605-609
    CrossrefPubMedGoogle Scholar
  • 19 Thabet FC, Ejike JC. Intra-abdominal hypertension and abdominal compartment syndrome in pediatrics. A review. J Crit Care 2017; 41: 275-282
    CrossrefPubMedGoogle Scholar
  • 20 Naji H, Foley J, Ehren H. Use of Surgisis for abdominal wall reconstruction in children with abdominal wall defects. Eur J Pediatr Surg 2014; 24 (01) 94-96
    PubMedGoogle Scholar