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lüll Challenges and outcomes of management of anterior abdominal wall defects in a Nigerian tertiary hospital Abdur-Rahman LO; Abdulrasheed NA; Adeniran JOAfr J Paediatr Surg 2011[May]; 8 (2): 159-63BACKGROUND: 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). MATERIALS AND 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.|Abdominal Wall/*surgery[MESH]|Adolescent[MESH]|Adult[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Gastroschisis/diagnosis/*surgery[MESH]|Gestational Age[MESH]|Hernia, Umbilical/diagnosis/*surgery[MESH]|Humans[MESH]|Infant, Newborn[MESH]|Male[MESH]|Plastic Surgery Procedures/*methods[MESH]|Retrospective Studies[MESH]|Surgical Wound Dehiscence/*surgery[MESH]|Treatment Outcome[MESH]|Young Adult[MESH] |