Successful abdominal wall closure following collagen-based artificial dermis induced epithelialization for giant omphalocele: A case report.
Int J Surg Case Rep 2020;
75:464-468. [PMID:
33076196 PMCID:
PMC7527617 DOI:
10.1016/j.ijscr.2020.09.096]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022] Open
Abstract
A giant omphalocele (GO) is related to higher rates of morbidity and mortality.
No consensus exists on optimal GO management, which may be surgically challenging.
We report the successful GO management of a neonate with numerous complications.
We applied a collagen-based artificial dermis for epithelization as a new treatment.
Introduction
A giant omphalocele (GO) with marked viscero-abdominal disproportion is associated with surgical difficulty and higher morbidity and mortality rates. Despite various treatment strategies, no consensus exists on optimal GO management. We report the clinical course of a neonate with a GO who was successfully treated with abdominal-wall closure through the novel application of collagen-based artificial dermis (CAD) for epithelization.
Presentation of case
A female neonate (estimated gestational age, 38 weeks; birthweight, 3.047 kg) with a GO where most viscera, including the liver, were completely herniated. G-band analysis showed no chromosomal abnormality and normal karyotype. Conventional silo formation was attempted, but incomplete silo was formed due to adhesion between the portal vein and fascia, and repatriation of the herniated viscera had not progressed. A new silo was formed using biomaterial, but it was infected and removed. Abdominal wall epithelialization using NPWT was attempted again but was interrupted by the occurrence of jejunal perforation. After incising the epithelialized part of the abdominal wall and repairing the perforated jejunum, the GO was covered and fixed using CAD. Epithelialization progressed well, and she was discharged on day 328.
Discussion
In this case, the major therapeutic challenges (including formation of an incomplete silo, silo infection, and jejunal perforation) were overcome with conventional treatment except for epithelialization of the abdominal wall, which was achieved by using CAD.
Conclusion
The treatment with CAD for epithelialization can be considered in cases where it is extremely difficult to return the viscera in conventional management.
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