Vitellointestinal Duct Anomalies in Infancy.

Yogender Singh Kadian,Pardeep Kajal,Anjali Verma,Kamal Nain Rattan

doi:10.21699/jns.v5i3.351

Yogender Singh Kadian, Pardeep Kajal + Show 2 more

Open Access

https://doi.org/10.21699/jns.v5i3.351

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Abstract

Background: Vitellointestinal duct (VID) or omphalomesenteric duct anomalies are secondary to the persistence of the embryonic vitelline duct, which normally obliterates by weeks 5–9 of intrauterine life. Methods: This is a retrospective analysis of a total of 16 patients of symptomatic remnants of vitellointestinal duct from period of Jan 2009 to May 2013. Results: Male to female ratio (M:F) was 4.3:1 and mean age of presentation was 2 months and their mode of presentation was: patent VID in 9 (56.25%) patients, umbilical cyst in 2(12.25%), umbilical granuloma in 2 (12.25%), and Meckel diverticulum as content of hernia sac in obstructed umbilical hernia in 1 (6.25%) patient. Two patients with umbilical fistula had severe electrolyte disturbance and died without surgical intervention. Conclusion: Persistent VID may have varied presentations in infancy. High output umbilical fistula and excessive bowel prolapse demand urgent surgical intervention to avoid morbidity and mortality.

Highlights

The omphalomesenteric duct (OMD) is an embryonic structure, which connects the yolk sac to the midgut and failure of its resorption results in various anomalies including Meckel's diverticulum, patent vitelline duct, fibrous band, sinus tract, umbilical polyp and cyst, enteric fistula with ileal intussusception prolapsing over the umbilicus or hemorrhagic umbilical mass
Among 9 patients who presented in neonatal period, 6 patients had umbilical prolapse of ileal loop and remaining 3 came with complaint of fecal discharge from umbilicus (Fig. 1)
Exploratory laparotomy via either transumbilical (n=6) or infraumbilical (n=8) approach was done in all except 2 patients; resection with anastomosis was performed for persistence of vitellointestinal duct (n=9), Meckel’s diverticulum as content of hernial sac (n=1)

Summary

Introduction

The omphalomesenteric duct (OMD) is an embryonic structure, which connects the yolk sac to the midgut and failure of its resorption results in various anomalies including Meckel's diverticulum, patent vitelline duct, fibrous band, sinus tract, umbilical polyp and cyst, enteric fistula with ileal intussusception prolapsing over the umbilicus or hemorrhagic umbilical mass These anomalies occur in approximately 2% of the population and may remain silent throughout life, or may present incidentally with an intraabdominal complication.[1] In newborns and infants these anomalies manifest as a mass, prolapsing ileal loop or discharge over the umbilicus and needs urgent surgical intervention.[2,3,4] In the present report we are presenting our experience of managing these anomalies in newborns and infancy in a tertiary care hospital of Northern India. High output umbilical fistula and excessive bowel prolapse demand urgent surgical intervention to avoid morbidity and mortality

Methods

Results

Conclusion