Abstract
ObjectiveThe aim of this study was to evaluate the clinical presentation and surgical management of omphalomesenteric duct (OMD) remnants in children. Material and methodsA descriptive retrospective study was conducted at the Department of Paediatric Surgery of the National Institute of Child Health, Karachi, Pakistan, from April 2017 to January 2020. Children below 12 years of age with various OMD remnants were included in the study. Data regarding age of presentation, type of anomaly, and management collected during this period were reviewed and analyzed using SPSS Version 22 (IBM Corp., Armonk, NY, USA).ResultsA total of 86 patients, 47 males and 39 females, were managed during the study period. Intestinal obstruction was observed in 44 (51.16%) cases followed by OMD-related umbilical anomalies in 14 (16.27%) cases, acute abdominal pain in 12 (13.95%), rectal bleeding in 3 (3.48%) patients. In 13 (15.16%) cases, Meckel’s diverticulum was discovered incidentally. In 21 cases, wedge resection and ileal repair was performed, whereas 32 required segmental resection and end-to-end anastomosis, and in 32 cases ileostomy was created after resection. Histopathology showed the presence of ectopic mucosa in five cases.ConclusionPatients with OMD remnants had various presentations. The surgical procedure has to be tailored according to the clinical and surgical findings.
Highlights
The omphalomesenteric duct (OMD), called the vitelline or vitellointestinal duct (VID), is an embryonic structure providing communication from the yolk sac to the midgut during fetal development [1]
Intestinal obstruction was observed in 44 (51.16%) cases followed by OMD-related umbilical anomalies in 14 (16.27%) cases, acute abdominal pain in 12 (13.95%), rectal bleeding in 3 (3.48%) patients
Careful assessment is required to differentiate them from a variety of anomalies that can occur at this site such as umbilical granuloma, urachal remnants, or omphalitis [14]
Summary
The omphalomesenteric duct (OMD), called the vitelline or vitellointestinal duct (VID), is an embryonic structure providing communication from the yolk sac to the midgut during fetal development [1]. The intra-abdominal components of OMD remnants may remain asymptomatic or are incidentally discovered during a laparotomy for other reasons. Those who become symptomatic can have a wide range of presentation based on the underlying anomaly. This include complications such as intestinal obstruction secondary to the band, intussusception, internal herniation, volvulus, or acute abdominal pain due to Meckel’s diverticulitis [4]. Heterotrophic tissue is known to be associated with OMD remnants, with Meckel’s diverticulum This predisposes to local hyperacidity and mucosal ulceration, causing recurrent abdominal pain or per rectal bleeding in children [6,7]. The aim of this study was to gather a single institutional experience on the various OMD remnants in children with an emphasis on the age and clinical presentation, intra-operative findings, surgical intervention performed, and the histopathological outcome
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