1149 An Unusual Presentation of Meckel's Band in the Neonatal Period

Abstract

Background and aims: We report a neonate with a ‘four vessel’ umbilicus, intrauterine volvulus and intestinal perforation secondary to a persistent Omphalomesenteric duct (OMD) / Meckel's band.Case description: A female infant was born at 38 weeks in poor condition requiring extensive resuscitation. She was noted to have a grossly distended, tense, discolored abdomen with distended veins, diaphragmatic splinting and hypovolaemic shock. Four vessels were visualized in the umbilicus, one of which was an unusual brown color and a diagnosis of volvulus secondary to OMD remnant considered.Abdominal x-ray showed a moderately distended, featureless abdomen. Ultrasound scan showed gross ascites of an abnormal dense echogenicity with intestinal debris in keeping with perforation.Laparotomy findings included bowel perforation, Meckel's band with volvulus, and a large meconium cyst. The unviable distal small bowel and ascending colon, which had volved around the OMD band, were excised. A stoma was fashioned proximal to this. She made a good recovery prior to discharge.Conclusions: Our case highlights the clinical significance of a ‘fourth umbilical vessel’ and the risks of OMD bands. Failure to recognise a persistent OMD remnant in the umbilical cord, or to refer the neonate for further investigation, may place the newborn at risk of developing serious complications in early life.