title: Challenges and outcomes of management of anterior abdominal wall defects in a Nigerian tertiary hospital.
abstract: BACKGROUND
  Abdominal wall defect presents a great challenge when it is large, ruptured, or associated with other anomalies.
  
  
  OBJECTIVE
  To review the challenges and outcome of management of anterior abdominal wall defects (AAWD).
  
  
  METHODS
  A retrospective review of omphalocele and gastroschisis managed over 8 years at our institution.
  
  
  RESULTS
  Omphalocele (n=49) and gastroschisis (n=7) constituted 2.4% of total admission. The median age was 23.5 hours, with male-female ratio of 1:1.1. Term infants were 91.7% and more than 75% weighed above 2.5 kg. The mean maternal age was 28.5±5.87 years and mean parity was 3.1±2.0, with P values of 0.318 and 0.768, respectively. More than 92.9% of infants were out-born, 46 pregnancies (82.1%) were booked, and 51 (91.1%) had at least one ultrasound scan, but only 1 (1.8%) was diagnosed with gastroschisis. Ruptured omphalocele were 11 (6 major, 5 minor) in number, 3 of which presented with enterocutaneous fistula, and 3 (6.1%) were syndromic omphalocele. Positive blood culture confirmed septicaemia in 21 cases (37.5%). Surgical repair was done in 35 cases (62.5%), 44.6% as emergency, and 17.9% as elective. Non-operative management was done in 21 patients (37.5%) and 5 (8.9%) were discharged against medical advice. Median length of hospital stay was 10 days (mean, 15.98±14.38). Postoperative complication rate was 32.1% and overall mortality was 30.4%, with the highest case fatality among gastroschisis (57.1%) and omphalocele major (32.1%).
  
  
  CONCLUSIONS
  There were large numbers of out-born infants due to poor prenatal diagnosis in spite of high instances of antenatal ultrasound scan. Many patients presented with complications that resulted in poor outcome.
authors: Paediatric Surgery Unit, Department of Surgery, University of Ilorin, University of Ilorin Teaching Hospital, Nigeria. bolarjide@yahoo.com
authors: Lukman O
authors: LO
authors: Abdur-Rahman
authors: Nasir A
authors: NA
authors: Abdulrasheed
authors: James O
authors: JO
authors: Adeniran
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000175:diagnosis / Q000601:surgery*; D005865:Gestational Age; D006554:Hernia, Umbilical / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult