Omphalocele and gastroshisis: A 14-year study

Introduction: Omphalocele and gastroschisis are developmental defects of the anterior abdominal wall, which have only recently been categorized as separate entities. In both cases, it is a herniation of abdominal organs through appropriate defects of the anterior abdominal wall. It is considered that the omphalocele are quite often developmental anomalies and are often associated with other developmental disorders, unlike gastroschisis, which usually occur isolated. Aims of the study: To determine the frequency of cases of omphalocele and gastroschisis in the Clinical Center of Banja Luka in the period from 2000 to 2013. Patients and methods: Insight into medical records, a retrospective analysis of all cases of congenital defects of the anterior abdominal wall at the Clinical Center of Banja Luka was done from the year 2000-2013. The analysis included all cases of omphalocele and gastroschisis, and prematurity, associated anomalies, the rate of mortality in the first year, exposure to environmental factors during pregnancy, maternal diabetes, maternal age, and familiar occurence of these anomalies were taken into consideration. Cases of „the prune belly“ syndrome and umbilical hernia were not included in this research. Results: During the period 2000-2013, there was a total of 19 cases of omphalocele, of which eigth live births. In the same period there was 14 cases of gastroschisis, and there was seven children born alive with this defect. In 73 percent of omphalocele cases there was associated anomalies, while this rate at gastroschisis was significantly lower and amounted to 28 percent. Among the live births, prematurity rate was 37.5 percent for the omphalocele group and 57 percent for the group of gastroschisis. The mortality rate in the first year of life was 25 percent for omphalocele and 14 percent for gastroshisis. In all these cases, the cause of death was not directly related to abdominal defect, but the associated complications (respiratory distress in the first place). Half of the mothers from both groups stated that they had used some medicines or consumed cigarettes during pregnancy. There was also a single incident of gestational diabetes in the group of omphalocele and one case of a positive family history from the gastroschisis group. Discussion: In this study, the relation of omphalocele and gastroshisis was 19/14 or 1.3:1, compared to the expected 3:2 ratio in the world literature. Other studies around the world show a higher incidence of gastroschisis and lower incidence of omphalocele. We had no reported cases of stillbirths in omphalocele group although, in the world literature, data of 11-12 percent were noticed . The reason for this discrepancy could be a different criteria for stillbirth compared to abortion, and perhaps the reporting was biased. The percentage of associated anomalies was higher in group of omphalocele, and similar results were reported in other studies. The mortality rate in thefirst year of life in a group of omphalocele was much higher when compared to gastroschisis group. For unknown reasons, stillborn children with omphalocele were not represented in this study. 56 Scripta Medica Vol. 46 • No 1 • April 2015. • www.scriptamedica.com