This is a case series study with a documentary focus based on the clinical and therapeutic characteristics of three patients hospitalized for omphalocele. The study was conducted at the La Bavière Health Pediatric Medical Center in Durba, Haut Uélé, Democratic Republic of the Congo, over a period from January 2024 to April 2025. This hospital is a regional reference center for the treatment of congenital malformations and, above all, for health promotion, with a capacity of more than 100 beds, which justified the choice of this site as the study location.

The cases included correspond to newborns admitted with a confirmed clinical diagnosis of omphalocele, i.e., three cases during the period of our study. The inclusion criteria required a complete medical record, including demographic data, morphological characteristics of the malformation, therapeutic modalities, and hospital progress. Patients who were transferred without follow-up or whose records were incomplete were excluded in order to ensure the validity of the observations. Infants and newborns with other malformations not consisting of a diagnosis of omphalocele were also excluded.

Omphaloceles were grouped into three categories according to the anatomical or morphological classification, including Type I (minor or small omphalocele: containing only intestinal loops, generally < 5 cm), Type II (major or large omphalocele: containing the liver, sometimes the stomach and other viscera, ≥5 cm), and Type III (giant omphalocele with a large sac > 8 - 10 cm and massive exteriorization of the liver and digestive tract) [3][4].

The variables studied included age, sex, geographical origin, size and contents of the omphalocele sac, the presence of associated anomalies, and surgical or conservative treatment modalities. Data were extracted from admission records, surgical reports, and nursing notes, then recorded in a standardized grid. Data collection was performed by a single investigator in order to limit transcription bias and ensure consistency of information.

The analysis was based on descriptive methods, with calculation of frequencies, proportions, and measures of central tendency adapted to the small sample size. The results are presented in the form of narrative descriptions detailing the evolution of each patient. This close, quantitative, and qualitative analysis highlights the similarities and differences between cases, while contextualizing local care practices.

The study was conducted in accordance with the ethical principles of the Declaration of Helsinki, with data anonymization and prior institutional authorization. Parental consent was sought for the use of information for scientific purposes. The main limitations are the small sample size and the absence of a comparison group, which limits the generalizability of the results.

However, this case series makes a relevant contribution to the regional literature on omphalocele and highlights the specific challenges of care in a resource-limited setting.

We received three cases of omphaloceles out of 35 cases of congenital malformations recorded over a 14-month period, which is a low frequency compared to the Malian series, which includes 72 cases over three years [2], or the Ivorian series, which includes 80 cases over nine years, and the Cameroonian series, which includes 10 cases over five years [5][6].

Our study covers a small series, but it shows that unlike in countries where surgery is successful in cases of omphalocele, in our countries with limited resources and in the absence of associated malformations, the non-operative management of progressive compression dressing using sterile compresses and an antimicrobial such as flamazine is effective, held in place with Velpeau bandages and adhesive tape, it is often offers a safe, accessible, and beneficial solution compared to surgery with all its complications and high risk of death [6]-[9].

The high frequency of type I omphaloceles, 66% in our study, is similar to the Cameroonian series (60%), but too high compared to the series by Kanté et al., who found 26% of type I omphaloceles, and the series by Kouamé et al., who found 44% of the same type.

Gender does not appear to be a risk factor. Several studies [10], including ours, found more boys than girls (two boys and one girl). This male predominance is also found in the literature [11]. However, there is still no consensus regarding this male predominance. Girls outnumbered boys in an American study [12].

The clustering of omphalocele cases in mining areas is a noteworthy finding that raises concern about environmental teratogens. Artisanal mining in regions such as Nord-Kivu frequently involves exposure to heavy metals (lead, cadmium, arsenic, mercury) and cyanide, which are well-documented for their teratogenic potential. These substances can cross the placenta, disrupt embryonic development, and have been associated with congenital malformations, including abdominal wall defects, in both human and animal studies [13]-[15]. Chronic maternal exposure through contaminated water, food, or inhalation of dust may therefore contribute to the occurrence of omphalocele in these communities, highlighting the need for environmental health surveillance and targeted epidemiological studies.

In addition to environmental risks, delays in neonatal admission remain a major determinant of poor outcomes. While in developed countries newborns with omphalocele are admitted immediately after birth [16][17], our study observed delays ranging from 3 to 7 days, longer than those reported by Bankole (2 days) [18], Kouamé et al. (24 hours) [19], and Malagasy (24 hours) [20]. Such delays increase the risk of complications such as infection and rupture of the sac [21][22]. Contributing factors include scarcity of neonatal services, long distances with impassable roads, and lack of medical transport. Training staff in peripheral health centers to stabilize neonates prior to transfer could improve survival rates, especially in resourcelimited and environmentally hostile settings such as mining zones.

According to the literature, the risk of malformation appears from the age of 30, but especially after the age of 35 [8]. The highest risk is between the ages of 35 and 40 [4][9][23]-[25]. Chromosomal abnormalities in children of older mothers are common [23]. The age of mothers in our series ranged from 15 to 35 years, which is consistent with Hamisu’s 2005 retrospective study in the US covering the period from 1983 to 1999, which found that 89% of mothers of 1010 children with omphalocele were young and 11% were older [7][8].

The rate of vaginal delivery in our series (66.7%) is similar to that in Tunisia and Côte d’Ivoire [25]-[28]. This contrasts with developed countries, where there is a high rate of cesarean sections, which is thought to be related to the development of prenatal diagnosis, which raises the possibility of obstetric indications [21]. In our setting, some deliveries take place in remote health centers without a doctor to make a clinical diagnosis of omphalocele.

When there are no visceral malformations, patients with omphalocele are more likely to survive than those with associated visceral malformations [26]. This is equivalent to our case, where all patients survived, with a 100% recovery rate, unlike other African series where mortality is 20% to 30% [19][22][23]. This mortality rate remains high for a benign condition compared to Western series, which are increasingly treated surgically with survival rates between 97% and 100% [11][29][30].

The absence of associated congenital malformations in our study or their low frequency in other African studies (11 cases of associated malformations for Kouamé et al. in a series of 80 omphaloceles) may be linked to the limitations of our cardiac examination methods, both antenatally and immediately postnatally [11][27][30].

However, the frequency of these associated malformations means that they must be investigated, given their importance in the prognosis for the treatment of omphalocele [4][17].

The same applies to prenatal diagnosis, which was not performed in our patients, even though this diagnosis is increasingly recommended and introduced in Africa, with 10% of antenatal diagnoses in an Ivorian series [27][30]. In our context, the majority of pregnant women do not receive ideal care. Ultrasound scans are not performed, or are performed by poorly qualified staff. However, the value of this examination is well established in the prognosis of omphaloceles and the search for associated malformations. This practice makes it possible to plan for the mother-to-be to give birth in a suitable healthcare facility, thereby reducing infectious complications in particular [31].