Conservative treatment of exomphalos.

Conservative treatment of exomphalos or omphalocele recommended by us in our textbook and performed by us in suitable cases for many years is not a panacea but has a limited application (Grob, 1957). This is due to the fact that in a high percentage (according to our own experience in more than 40% of cases) primary complications are present, requiring an early operation, or the condition is so serious that any kind of treatment will be hopeless (Fig. 1). Such a primary complication is rupture of the omphalocele sac, and if the evisceration has occurred before birth the outlook is very poor. We have seen seven cases of this kind and all died. Another complication needing urgent intervention is intestinal obstruction due to adhesions between the sac and the intestine or by strangulation at the umbilical ring with or without formation of a secondary atresia or by torsion of the sac due to volvulus of the subjacent bowel (Figs. 2 and 3). In many cases the malformation is associated with other and often multiple serious anomalies such as malrotation or total failure of the foetal intestinal rotation, heart disease, mongolism or the like. In three cases we saw large defects of the skull with congenital ulcers of the galea. Conservative treatment is therefore only feasible in cases without such primary complications. The principle of the treatment lies in the fact that the