Ruptured and Non-Ruptured Omphaloceles: Characteristics, Management and Mortality Risk Factors in a Nigerien Cohort.

BACKGROUND

Omphalocele is a congenital anterior abdominal wall defect classified by size and sac integrity. In resource-limited settings, ruptured forms, low birth weight and delayed referral are associated with high mortality, yet ruptured and non-ruptured forms are seldom compared directly.

AIM: To evaluate the distinctive diagnostic, therapeutic, and prognostic aspects of ruptured and non-ruptured omphaloceles.

METHOD: This prospective, descriptive study included all patients with omphalocele admitted to the Paediatric Surgery Department of the National Hospital Amirou Boubacar Diallo Niamey, Niger between 1st August, 2023 and 28th February, 2025 (19 months). Sociodemographic, diagnostic, therapeutic, and outcome variables were analysed. Patients with ruptured and non-ruptured omphaloceles were compared using the Mann-Whitney and chi-square tests and Student's t-tests (p<0.05 was considered significant).

RESULTS

Eighty patients were included (5.6% of all hospitalizations), and mean admission age was 1.76 days (median, 18 h). Regarding prenatal care, only 6.25% (n=5) of the patients attended ≥6 consultations, and 14.64% (n=6) had antenatal diagnoses. Patients with ruptured omphaloceles (41.25%, n=33) showed significantly lower birth weight (p=6.54×10⁻¹⁹), higher primigravid prevalence (p=0.04), and younger maternal age (p=6.54×10⁻¹⁹) than those with non-ruptured omphaloceles. Pre-referral management gaps included absent nasogastric tubes (97.5%, n=78), delayed intravenous access (76.25%, n=61), and inadequate sac protection (36.25%, n=29). Treatment included the Grob (60%, n=48) and Gross (18.75%, n=15) techniques. Complications (18.75%, n=15) were predominantly due to sepsis (n=6), and the mortality rate was 51.25% (n=41), which was due to sepsis (n=12) and respiratory failure (n=8). Ruptured omphalocele (p<0.00000001), low birth weight (p=0.0039), admission delay (p=6.53×10⁻¹⁹), and primigravidity status (p=0.0237) correlated with mortality.

CONCLUSION

This study highlights the critical impact of ruptured omphalocele, low birth weight, and delayed admission on omphalocele mortality in Niger. The increasing incidence and clear causes of ruptured omphalocele remain to be explored.