Omphalomesenteric Duct Remnant Research Articles

Various Clinical Manifestation of Omphalomesenteric Duct Remnant in a Child: A Case Report

Omphalomesenteric duct (OMD) remnant is a condition in which the omphalomesenteric duct fails to obliterate completely or partially. Failure in this step can produce various patterns, such as a vitelline cyst, umbilical sinus, polyp, Meckel’s diverticulum, and patent OMD. Various clinical manifestations of OMD rarely occur in one patient. We present the case of omphalomesenteric duct remnant, manifested as anterior wall abdominal mass, intraperitoneal hemorrhage, and obstructive ileus. Case report: A four-year-old girl was referred to our hospital with obstructive ileus and abdominal wall mass on the left lower quadrant. Contrast-enhanced abdominal computed tomography (CT) scan found an irregular cystic mass in the abdominal cavity that adheres to the anterior wall of the abdomen and bowel structure with a fluid-solid level without enhancement. Further medical history was taken and found a history of intermittent watery umbilical discharge that appears three times in 2 years after birth. Omphalomesenteric duct remnant was suspected, then proceed to exploratory laparotomy. We found intraperitoneal hemorrhage and 5x4 centimeters frail mass adhering to the anterior wall of the abdomen on the left side of the umbilicus. Histopathological examination confirmed intestinal tissue, suggesting remnants of the omphalomesenteric duct and pancreatic tissue with a chronic inflammatory pattern. Diagnosing omphalomesenteric duct remnant could be challenging and should be considered a differential diagnosis of obstructive ileus, particularly if persistent umbilical discharges are also present. On the other hand, early diagnosis and appropriate management of persistent umbilical discharge could prevent a greater outcome.

Successful Management of the Omphalomesenteric Fistula: About Three Case Reports

The omphalomesenteric duct is an embryologic connection between the midgut and yolk sac, which typically disappears at the 5th to 7th week of gestation. Failure of the obliteration process can lead to omphalomesenteric duct remnants. It usually has a difficult diagnosis, manifested by a variety of cutaneous signs, such as an umbilical mass, granulation tissue, or discharge. This article reports three cases of total persistence of the OMD and reviews the surgical management of those lesions. The first case reports a 6-day-old boy with a patent omphalomesenteric duct fistula opening to the umbilicus presenting with feces sprouting from the umbilical stump. The second one reports a one-month-old infant brought to the hospital with umbilical granuloma, with no response to topical treatment that later started draining feces from the umbilical cord. The third one reports a three-day-old male newborn that manifested a granuloma-like lesion on the umbilical scar with no improvement with topical treatment. A simple catheterization with a relation catheter was performed in all cases showing drainage of a bilious secretion. they were then diagnosed with a persistence of the Vitelline Duct. All infants had a similar surgical approach, with an abdominal elective incision made around the lesion on the abdominal wall. Identification of the fistula trajectory, followed by resection of the bowel segment that contains the fistulae and a formation of a terminal-terminal anastomosis.

Combination of Urachal and Omphalomesenteric Duct Remnant: A Rare Case Reports

Umbilical problems encountered in the pediatric population are often associated with retained umbilical cord structures or with failure of the umbilical ring to close at birth. This article reported a case of umbilical anomalies in 3-years old male, with a chief complaint of a lump on the umbilical area a urinary discharge from the umbilical since birth. Incidence of patent vitelointestinal duct (omphalomesenteric duct) varies from 1 in 5000-8000 while patent urachus are still rare, ranging from 1-2 per 100000. The combination of both anomalies is very rare, only 12 reported cases since 1898 until 2016. Ultrasound can play an important diagnostic role for these types of anomalies if performed by expert. In our case, the ultrasound was not able to confirm the diagnosis due to a lot of gas in the abdomen. Based on clinical data and histopathologic examination, the patient was diagnosed with combination of urachal and omphalomesenteric duct remnant.

Ectopic pancreas, gastric, duodenal and colonic tissue in a case of persistent umbilical discharge: Report of two patients with review of literature.

One of the typical complaints in the pediatric population is umbilical discharge. Among the congenital causes, remnants of omphalomesenteric duct or patent urachus are often detected. On a few occasions, multiple types of ectopic tissue are present. We describe histopathologic findings of two cases reported recently at our center as pediatric umbilical lesions with associated ectopic tissue. Histopathology of the excised mass confirmed the patent omphalomesenteric duct with ectopic gastric, duodenal, and colonic mucosa and pancreatic tissue in two patients with the clinical presentation of umbilical discharge. There were no associated congenital anomalies in these patients. The presence of multiple ectopic gastrointestinal mucosa and pancreas in the umbilical mass is unusual. Herein, we report these cases because of its rarity, multiple ectopic tissues, and reviewing the literature of the reported cases of multiple ectopic tissues.

A Rare Case of Remnant of Omphalomesenteric Duct Presented with Umbilical Sinus with Granuloma in an Adult

The omphalomesenteric duct (OMD) is an embryonic structure connecting the yolk sac to the midgut. Failure of the resorption of the duct results in several anomalies. These anomalies usually occur in approximately 2% of the population. Individuals having such anomalies may remain asymptomatic throughout life. The embryonic vitelline duct obliterates in 5 to 9 weeks of intrauterine life normally. Persistence of this results in vitellointestinal duct/ omphalomesenteric duct anomalies. It is usually seen in the paediatric age group. Moreover, they have a different course in adults than the paediatric age group in which they frequently involute and have a benign course. These remnants are prone to infection and development of malignancy. A proper diagnostic workup by clinical and imaging tools is required. Hereby we have reported a rare case of remnant OMD which presented as an umbilical sinus with a granuloma in an adult patient.

Concurrent omphalomesenteric duct cyst and ileal diverticulum causing small bowel obstruction; a case report.

Introduction and importanceThe omphalomesenteric duct (OMD) usually involutes by the ninth gestational week. If this obliteration fails, OMD remnant will result in different pathologies mostly in the pediatrics and infrequently in adults. The most well-known OMD remnant disease is Meckel's diverticulum. Omphalomesenteric cyst is rather rare, and their combination is even more exceptional with few cases in literature.Case presentationWe present an adolescent patient with nausea and vomiting and occasional periumbilical abdominal pain who was diagnosed with concurrent omphalomesenteric cyst and ileal diverticulum, causing internal hernia and bowel obstruction that underwent surgery.Clinical discussionOMD remnants mostly present in childhood with symptoms of intestinal obstruction, and rarely internal hernias for which conservative management is usually not curative, warranting surgery. Imaging presence of cystic lesion in mid abdomen in young patient with bowel obstruction should raise the suspicion for OMD remnants. Presence of OMD cyst together with Meckel's diverticulum necessitates more extensive resection, rare concurrence which is better to be prepared for in advance.ConclusionPreoperative radiologic workup is helpful to diagnose the obstruction and its probable cause. Presence of periumbilical cyst should raise the suspicion of OMD remnant specially in young adults with previous episodes of crampy abdominal pain and obstruction without history of abdominal surgery. Being familiar with possible concurrence of OMD cyst and Meckel's diverticulum will increase preparedness at the time of surgery.

Remenant of vitellointestinal duct with vitelline cyst causing volvulus of small bowel

We report a case of 14 year old male who presented with abdominal pain for 1 day. Our initial clinical suspicion was complicated acute appendicitis, which was later supported by ultrasonogram. His CT abdomen revealed acute intestinal obstruction. Subsequently he was taken up for emergency laparotomy which revealed a fibrous cord like remnant of vitellointestinal duct with a Vitelline cyst causing volvulus of small bowel. The cord along with cyst was excised. The gangrenous bowel was resected and an ostomy was fashioned. Post operative period uneventful and evaluation for any associated congenital malformations revealed none.

Surgical perspectives of symptomatic omphalomesenteric duct remnants: Differences between infancy and beyond

BACKGROUNDThe clinical manifestations of omphalomesenteric duct remnant (OMDR) can vary with the age at diagnosis, from asymptomatic incidental findings to symptoms related to gastrointestinal complications. The lifelong complication rates are reported as 4%-34%, and complications are more common in patients younger than 2 years of age. The authors attempted to identify different clinical features and management for the various pediatric age groups.AIMTo find surgical perspectives for the pediatric age-related variants of OMDR and make recommendations for optimal management.METHODSThe medical records of pediatric patients diagnosed with OMDR were reviewed retrospectively. Fifteen patients diagnosed based on incidental findings during other surgeries were excluded. The patients were divided into two groups based on age: < 12 mo (infants) and > 12 mo (beyond infancy). We analyzed the demographic characteristics, clinical manifestations, diagnostic tools, surgical procedures, and clinical outcomes of the patients and compared them for the age groups. Chi-squared and Fisher's exact tests were used for nominal scales and a Mann-Whitney test was used for ratio scales.RESULTSA total of 35 patients (7 infants, 28 children beyond infancy) were finally included. In both groups, Meckel's diverticulum (MD) was the most common type of OMDR, while umbilical lesions were more common in the infant group (P = 0.006). Hematochezia and abdominal pain were common in the beyond infancy group, while umbilical lesions were the most frequent symptoms in the infant group. Several diagnostic tools were used, but Meckel's scan was most useful in diagnosing OMDR in patients with painless rectal bleeding. Minimally invasive surgery was more commonly performed for children than for infants (P = 0.016). Single-incision laparoscopic surgery (SILS) was performed for fifteen patients who underwent laparoscopic surgery. There were only three cases of postoperative complications, and all patients survived in good condition.CONCLUSIONThe clinical type of OMDR varies with age, umbilical lesions in infants, and MD beyond infancy. SILS is effective for managing children with MD regardless of age.

FOREIGN BODY PERFORATION OF MECKEL'S DIVERTICULUM IN A CASE OF ACUTE APPENDICITIS - TWIN PATHOLOGY : A RARE CASE REPORT

Meckel's diverticulum is a remnant of embryologic omphalomesenteric duct. It is the most common congenital anomaly in gastrointestinal tract with the incidence of about 2% in the population. About 80% of them are asymptomatic and remaining can present with complications such as bleeding, ulcer, intestinal obstruction, intussusception, diverticulitis and perforation. Meckel's diverticular perforation by a foreign body is a rare complication. Here we report a case of Meckel's diverticular perforation by a foreign body in a case of acute appendicitis. A 50 year old male patient presented to emergency department with signs and symptoms of acute appendicitis . Abdomen opened through Mc Burney's incision, appendix found to be inammed and a sh bone perforating the Meckel's diverticulum was incidentally found, appendicectomy and Meckel's diverticulectomy was performed. Perforation of Meckel's diverticulum by a foreign body is a diagnostic challenge pre operatively. It is suggested to make it a routine practice to look for the presence of Meckel's diverticulum in all lower abdominal surgeries.

Spectrum of Omphalomesenteric Duct Related Anomalies and Their Surgical Management in Children.

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.

Coscienza fluttuante, intestino sofferente

Altered state of consciousness in infants can be the sole sign of a compromised intestinal blood flow. The article reports the case of an infant with inconsolable crying and lethargy with an omphalomesenteric duct remnant causing small bowel volvulus.

Intestinal Obstruction Caused by a Vitelline Cyst in 28-year-old Male—A Case Report—

Intestinal Obstruction Caused by a Vitelline Cyst in 28-year-old Male—A Case Report—

Tuberculous Perforation of Meckel’s Diverticulum

Meckel’s Diverticulum (MD) is an example of a true diverticulum, consisting of all the three layers of small intestine. It is a remnant of omphalomesenteric (vitellointestinal) duct found on the antimesenteric side of the ileum. Perforation of MD is an uncommon complication of an effectively uncommon abnormality, which regularly mimics an appendicular perforation clinically. Although intestinal tuberculosis is a major issue in many parts of the world, a handful of cases of tubercular perforation of MD have been reported in the literature till date. This case of tubercular perforation of MD was reported due to the rarity of the condition and presence of fairly less literature on the topic. A 30-year-old male patient presented with abdominal pain, fever, vomiting. On examination, tachycardia, guarding, rigidity and rebound tenderness were observed. Exploratory laparotomy revealed perforation of MD with inflammation of ileum and caecum with dense adhesions. Proximal loop ileostomy was made. Histopathology showed features of tuberculosis. Postoperative recovery was uneventful and patient was started on antitubercular treatment and 4 kgs weight gain on follow-up after one month.

A Case of Infected Omphalomesenteric Duct Remnant in an Adult

A Case of Infected Omphalomesenteric Duct Remnant in an Adult

A rare combination of congenital anomalies following in utero methimazole exposure

Abstract The use of methimazole for the treatment of hyperthyroidism in the first trimester of pregnancy has been linked to several congenital malformations. Most commonly reported is choanal atresia; however, other anomalies have been described including aplasia cutis, esophageal atresia, omphalomesenteric duct remnant, and omphalocele. A definitive phenotype of methimazole embryopathy has not been described. We report a case of a newborn with prenatal methimazole exposure who was found to have an H type tracheoesophageal (TE) fistula, vitelline fistula, ruptured omphalocele, as well as multiple duplication cysts of the stomach and small intestine.

Symptomatic Omphalomesentric Duct Anomalies in Children: Analysis from a Paediatric Surgery Department Catering Primarily to the Rural Population

Introduction: Omphalomesenteric Duct (OMD) anomalies are rare congenital disorders of primitive yolk sac. The spectrum of OMD anomalies has varied clinical presentations. Aim: To study the spectrum and management of symptomatic OMD anomalies in children at a rural tertiary care centre. Materials and Methods: This was a retrospective study done at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, a tertiary care centre located in rural part of Northern India. Medical records of all children less than 15 years of age who were diagnosed with symptomatic OMD anomalies and managed surgically between January 2016 to December 2019 (four years) were carefully analysed and data were recorded. The recorded parameters were age, sex, symptomatology, clinical presentation, intraoperative findings, surgical procedure performed, complications that developed during the early postoperative period, length of hospital stay and Histopathology Examination (HPE) of the specimens excised. The collected data were statistically analysed. A p-value &lt;0.05 was considered statistically significant. Results: Records revealed that 40 children underwent surgeries for symptomatic OMD anomalies which constituted 6.21% of all surgeries (644) performed by the Department of Paediatric Surgery during January 2016 to December 2019 (four years). There were 29 males (72.5%) and 11 females (27.5%) (M:F=2.6:1). Out of 40 patients, 17 (42.5%) were infants and 23 (57.5%) were of post-infancy age. Mean age of cohort was 41.77 months. The three predominant clinical presentation in children were intestinal obstruction, acute abdomen and umbilical abnormalities. The commonest clinical presentation of the symptomatic OMD anomalies was umbilical abnormalities (50%). Clinical presentation of umbilical abnormality was significantly higher in infancy (p=0.0039*). The incidence of Meckel’s diverticulum was 50%. Wedge resection was the commonest surgical procedure performed (67.5%). On HPE, ectopic gastric mucosa was identified in 12 out of 40 patients (30%). Conclusion: Symptomatic OMD remnants have varied clinical presentation. Patients presenting with umbilical abnormalities are common in infancy. Presence of ectopic tissue is commoner in patients with symptomatic OMD remnants. Surgery is the treatment of choice.

You Bowel Believe It!

A 2-year-old previously healthy girl presented to the emergency department with sudden onset of nonbilious emesis and severe abdominal pain. Her clinical examination and point-of-care ultrasound were consistent with a small bowel obstruction. She had sonographic evidence of free fluid in the abdomen and subsequently developed hemodynamic instability. Further imaging was suggestive for a congenital anomaly causing her obstruction. She was ultimately diagnosed with an omphalomesenteric duct remnant, confirmed during an exploratory laparotomy.

A Case of a Patent Omphalomesenteric Duct Presenting with Meconium Discharge from the Umbilicus

The omphalomesenteric duct is a link between the primitive midgut and the yolk sac. Normally, the duct obliterates around 6 weeks of gestation, yet varying degrees of incomplete obliteration can take place in 1%–4% of infants. This study described the case of a newborn with a patent omphalomesenteric duct remnant fistula identified at birth with meconium in the umbilical cord. At birth, the infant presented meconium staining and meconium discharged within the umbilical cord. Physical examination and other examinations showed no other specific findings. The omphalomesenteric duct fistula was confirmed through the imaging study (abdominal ultrasonography, gastrografin enema). A surgery was carried out where the remnant was resected. The patient did well and was discharged soon after without complication. Key words: Patent omphalomesenteric duct; Meconium; Umbilical cord

Cutaneous presentations of omphalomesenteric duct remnant: A systematic review of the literature

Disorders of the umbilicus are commonly seen in infancy, including hernias, infections, anomalies, granulomas, and malignancies. Meticulous inspection of the umbilicus at birth might reveal a persisting embryonic remnant, such as an omphalomesenteric duct (OMD), manifested by a variety of cutaneous signs, such as an umbilical mass, granulation tissue, or discharge. To systematically review the available data regarding the presence and management of OMD remnant with cutaneous involvement to suggest a practical approach for diagnosis and treatment. A systematic review of the literature evaluating OMD anomalies presenting with cutaneous symptoms was performed. In addition, an index case of an 11-month-old patient is presented. We included 59 publications reporting 536 cases; 97% of the patients whose age was noted were infants (mean age 11months). In 7.5% of the cases, diagnosis was established only after treatment failure. In 6.4% of patients, nonlethal complications were reported, and in 10.3%, the outcome was death, partly due to delayed diagnosis or mismanagement. Limited quality of the collected data, reporting bias. OMD is relatively rare; however, the clinician must consider this remnant while examining patients with umbilical abnormalities because mismanagement could cause severe morbidity and mortality.

Demography of the remnant of omphalomesenteric duct

Introduction: Pediatric surgeons dealt with cases of omphalomesenteric duct remnants, which presented with various symptomatic patterns. Meckel's diverticulum was the most common remnant in this study, which presented with different signs and symptoms. The aim is to study the various remnants of omphalomesenteric duct with their presenting symptoms and to introduce a new variant of patent vitellointestinal duct (PVID) and describe how to treat these variants of omphalomesenteric duct. Materials and Methods: This is a retrospective study conducted in 132 neonates and children (102 male and 30 female), who were operated at our institute and containing persistent omphalomesenteric duct and its derivatives. This study was conducted from January 2017 to June 2018 at our institute. This study analyzed the presenting sign and symptoms of various remnants of omphalomesenteric duct. The study analysis was based on the following parameters – age, sex, sign, symptom, investigation, operative finding, and postoperative complications. Results: In this study, male-to-female ratio was 3.4:1. Meckel's band obstruction was the most common presentation (n = 48, 36.36%), while umbilical cyst (n = 1, 0.75%) and umbilical sinus were least commonly present (n = 1, 0.75%) in all remnants of omphalomesenteric duct. We found a new variant of PVID, which presented with an intact omphalomesenteric duct, but the umbilical end was obliterated. This variant had not been included or reported in literature. Conclusion: Omphalomesenteric duct remnants are presenting with various sign and symptoms, like intestinal obstruction, umbilical discharge, umbilical swelling, pain abdomen etc. A new variant of PVID is named end- obliterated PVID reported here, may present with features of intestinal obstruction.