Seitaro Kosaka, Takanori Ochi, Shuko Nojiri, Tadaharu Okazaki, Go Miyano
Juntendo University School of Medicine and Juntendo University Urayasu Hospital.
Japan
European Journal of Pediatric Surgery Reports
Eur J Pediatr Surg Rep 2026; 14: e45-e49
DOI: 10.1055/a-2937-1779
Abstract
Primary closure is a low-risk option for small omphaloceles (SOs). However, despite the absence of liver herniation and limited volume of herniated viscera, we encountered two cases of postoperative pulmonary hypertension (PH) and respiratory failure after closure for SO. This report discusses the safety of primary closure and potential factors that may be associated with postoperative PH in infants with SOs. Cases 1 and 2 presented with SOs without chromosomal abnormalities or liver herniation (gestational ages 36 and 37 weeks, birth weights 3,650 and 2,577 g, and defect sizes 4 and 2 cm, respectively). Prenatal ultrasonography showed no evidence of oligohydramnios in either case, and chest radiography was negative for chest wall deformity at birth. Primary closure was performed within 24 hours of birth after stabilization, defined as venous blood gas values without hypoxia/CO 2 retention, and echocardiographic confirmation of no PH. Arterial blood gas was assessed after abdominal wall closure and demonstrated critical respiratory failure with CO 2 retention, and both infants developed postoperative PH. However, low Apgar scores were noted (at 1 minute: 4 and 6 and at 5 minutes: 6 and 6 in Cases 1 and 2, respectively). One infant died from refractory PH, but the other responded to treatment. Even in SO, preoperative respiratory reserve, including information reflected by Apgar scores, may be carefully considered when determining the timing and feasibility of primary closure.
Category
Class I. Persistent Pulmonary Hypertension of the Newborn
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes