VERY RARE COMBINATION OF PATENT VITELLOINTESTINAL DUCT WITH PATENT URACHUS

Abstract

Introduction - The vitelline duct is the embryological narrow channel connecting the yolk sac with the intestine. During the foetal life, vitelline duct tends to obliterates itself till to disappear. The partial failure of this obliteration can lead to the development of a duct, a ligament, or a diverticulum known as a Meckel's diverticulum. A Patent omphalomesenteric duct occurs because of the complete lack of vitelline duct.[3] The urachus is an embryological remnant of the allantois. Between the fourth and fth month of gestation, the foetal bladder tends to descend gradually and its apical portion creates the urachus. The urachus obliterates itself, becoming the median umbilical ligament. Its persistence after intrauterine life can manifest as urachal remnants. A patent urachus is because of complete lack of obliteration of urachus [1,3]. The incidence of these anomalies PU was 1-2 per 10000 while PVD is 1 in 5000 to 8000 deliveries [1,3,5]. The association of both anomalies is very rare [7]. Case discussion- A 12-years-old male presented with complaints of pain in abdomen, multiple episodes of vomiting. Patient was tachycardiac with tenderness in right iliac fossa with palpable lump with ultrasonography suggestive of perforated appendix with lump formation and was managed conservatively and asked for interval appendicectomy with CECT abdomen. CECT was suggestive of normal and compressible appendix with infected urachal cyst. But after 4weeks patient had similar complaints hence posted for emergency operation with McBurney's incision not by midline incision to avoid injury to urachal cyst. Intra operative ndings-1) patent Vitello intestinal duct 2) patent urachus 3)15cc pus discharge near umbilical end of urachus 4) normal appendix and small bowel. Resection of Vitello intestinal duct and urachus with ileoileal anastomosis done and specimen sent for histopathology which was suggestive of patent vitello intestinal duct with changes of gangrene. The Patent Vitello Conclusionintestinal duct with patent urachus is very rarely seen in combination and its diagnosis may be missed preoperatively and should be kept as a possibility in patients with patent urachus with or without infection