Fistula between a patent omphalomesenteric duct and a ruptured omphalocele sac in a neonate

Abstract

This case report serves to document a rare case of a neonate who presented to the NICU with a patent omphalomesenteric duct (OMD) connected to the top of a ruptured omphalocele sac. Initial evaluation of the neonate in-utero led to the diagnosis of gastroschisis due to the presence of free-floating intestines on ultrasound. However, a ruptured omphalocele sac was discovered grossly upon delivery. Additionally, intestines were found in the midline of the abdomen, a common characteristic of omphaloceles. Therefore, the diagnosis was modified from gastroschisis to ruptured omphalocele. Further gross examination revealed a patent omphalomesenteric duct forming a fistula to the top of the ruptured omphalocele sac. After the appropriate workup and necessary procedures, the neonate had only one bowel movement over 2.5 weeks and was intolerant of food, raising suspicion for an intestinal atresia. Evaluation revealed a type 1 intestinal atresia distal to the patent OMD and omphalocele sac. The atresia was initially masked by bowel inflammation in the neonate at birth. Resection of the atretic bowel led to appropriate bowel movements and increased food intake. The neonate was eventually discharged in good health. • A patent omphalomesenteric duct has been observed to form a fistula with the top of an omphalocele sac in a neonate in-utero. • Ruptured omphalocele should be on the differential when in-utero ultrasound reveals free-floating intestines. • In neonates, intestinal atresia can initially be masked by inflammatory states from other complications.