Omphalomesenteric Duct Research Articles

The "rule of two" in Meckel's diverticulum - Does it truly apply to the pediatric population in our area?

Meckel's Diverticulum (MD) originates from the incomplete obliteration of the omphalomesenteric duct during the seventh week of gestation. The classic clinical description of MD follows the "rule of two: 2% of the population, 2 inches in length, 2 feet from the ileocecal valve, a 2:1 ratio between males and females, and presentation at two years of age. This study evaluates to what extent the "rule of two" applies to a Spanish pediatric cohort.

Symptomatic omphalomesenteric duct anomalies in children

Symptomatic omphalomesenteric duct anomalies in children

Incidentally Detected Meckel’s Diverticulum in an Adult, Resect or Not Resect? A Case Report

Introduction: Meckel's diverticulum is a true diverticulum that affects 2% of the population, being the most frequent congenital anomaly of the gastrointestinal tract and occurs due to a defect in the closure of the omphalomesenteric duct. It is most frequently diagnosed in children under 10 years of age, in whom it may manifest as gastrointestinal bleeding, obstruction or perforation; however, in adults it is usually asymptomatic and found incidentally during other abdominal surgery. Case presentation: A 43-year-old male, with acute appendicitis, underwent open appendectomy, during which the presence of a 4 x 3 cm Meckel's diverticulum was incidentally identified, so ileal resection was performed, with primary anastomosis, presenting a satisfactory postoperative evolution. Conclusion: The treatment of symptomatic Meckel's diverticulum is undoubtedly resection; however. The literature does not define whether a diverticulum found incidentally should be resected or not, especially in adults, in whom the presence of risk factors should be assessed to determine whether resection should be performed.

Monitoring egg fertility, embryonic morbidity, and mortality in an oviparous elasmobranch using ultrasonography.

Ultrasonography is widely used to monitor pregnancy in viviparous species, but it is underutilized as a tool to characterize embryonic development in oviparous species. Currently, a multi-institutional effort is underway to re-wild the endangered zebra shark (Stegostoma tigrinum) to locations where this species was previously extirpated by leveraging the reproductive efforts of aquarium sharks as a source of brood stock. Zebra sharks are oviparous and fecund, but a large percentage of their yolked eggs do not result in hatchlings. Therefore, ultrasonography represents a potential tool for distinguishing fertile eggs with developing embryos from degrading eggs, and to diagnose changes in early embryonic development predictive of poor outcomes. The objectives of the current study were to use ultrasonography to assess egg fertility, monitor early embryonic development, and identify morphological indicators that may be predictive of early embryonic mortality. Freshly laid eggs from four female zebra sharks were collected and inventoried daily at Aquarium of the Pacific. Eggs were incubated undisturbed for 2 to 4 weeks and subsequently examined weekly via ultrasound to assess fertility and monitor embryo development. Among 120 fertile eggs, embryos were identified as early as 8 days post-oviposition, with average (±SD) time to first observation at 30 ± 7 days. Morphological and behavioral abnormalities were observed for most embryos (n = 84, 70%) as early as 16 days and up to 95 days post-oviposition. Common abnormalities included: bent or curled tails, vesicle(s) at the base of the yolk stalk, and slow or weak movement. Only one embryo survived to hatch during the study and was genetically-confirmed parthenogenetic, suggesting hatching success for parthenotes is low (<1%). Ultrasonography was demonstrated to be an effective and non-invasive method to determine egg fertility, identify embryos with developmental abnormalities, and monitor embryo growth.

Laparoscopic management of small bowel obstruction secondary to a mesodiverticular band of a Meckel's diverticulum in an adult: A case report and literature review.

The mesodiverticular band (MDB) of a Meckel's diverticulum (MD) is a rare, yet notable etiology of small bowel obstruction (SBO) in adults. Due to the nonspecific symptoms and challenging diagnosis thereof, preoperative clinical suspicion and strategic management are crucial for achieving optimal outcomes. Therefore, we presented a case in which laparoscopic surgery was strategically performed to alleviate ileus, due to a preoperative diagnosis of SBO, suspected to be secondary to an MD with a concomitant MDB. A 32-year-old male patient presented with a half-day's duration of epigastric pain, abdominal distension, and tenderness, resulting in the working diagnosis of SBO. Initial non-contrast computed tomography (CT) revealed SBO without signs of strangulation, postulated to be caused by an MD and concomitant MDB, resulting in conservative management. The symptoms persisted, necessitating contrast-enhanced CT. However, the dilated bowel loop suggestive of an MD that had been observed on non-contrast CT could not be confirmed on contrast-enhanced CT. Decompression therapy using a long tube provided minimal relief, prompting laparoscopic surgery on the 5th day post-admission for diagnostic and therapeutic purposes. An MD resection effectively relieved the SBO. The histopathological analysis revealed a true diverticulum with ectopic pancreatic tissue, confirming the diagnosis of an MD. At the band site, vascular and neural structures were encased in a sheath, consistent with the remnants of the vitelline duct mesentery; and histopathologically diagnosed as an MDB. The postoperative course was uneventful, and the patient was discharged on the 9th day, postoperatively. Decompression therapy and strategic laparoscopic surgery based on the preoperative working diagnosis of SBO yielded favorable outcomes, highlighting the importance of the early clinical suspicion of an MD and a concomitant MDB, as the etiology of SBO. The imaging variability and rarity of an MD in adults emphasizes the need for a heightened awareness and an accurate diagnosis for optimal management. Early intervention should be deliberated for patients with suspected intestinal ischemia. However, this case accentuates the clinical implications of strategic planning and employing minimally invasive techniques in the management of an MD-related SBO in adults.

SUPPLEMENTAL DESCRIPTION OF CABALLEROTREMA ANNULATUM (DIESING, 1850) OSTROWSKI DE NÚÑEZ AND SATTMANN, 2002 (DIGENEA: CABALLEROTREMATIDAE) FROM A NEW HOST (ELECTROPHORUS CF. VARII) AND LOCALITY (AMAZON RIVER, COLOMBIA) WITH PHYLOGENETIC ANALYSIS AND EMENDED GENERIC DIAGNOSIS.

Herein, we provide a supplemental description of Caballerotrema annulatum (Diesing, 1850) Ostrowski de Núñez and Sattmann, 2002 (Digenea: Caballerotrematidae Tkach, Kudlai, and Kostadinova, 2016) based on specimens collected from the intestine of an electric eel, Electrophorus cf. varii (Gymnotiformes: Gymnotidae) captured in the Amazon River (Colombia). This caballerotrematid can be differentiated from its congeners by the following combination of morphological features: body surface spines forming contiguous transverse rows, concentric (wrapping dorso-ventrally around body), distributing into posterior body half (vs. restricted to anterior body half in Caballerotrema brasiliensePrudhoe, 1960; indeterminate for Caballerotrema aruanenseThatcher, 1980 and Caballerotrema piscicola [Stunkard, 1960] Kostadinova and Gibson, 2001); head collar lacking projections (vs. having them in C. brasiliense, C. aruanense, and C. piscicola), narrow (head collar more narrow than maximum body width vs. the head collar being obviously wider than the body in C. brasiliense, C. aruanense, and C. piscicola); corner spines clustered (vs. corner spines distributing as 2 separated pairs in C. brasiliense, C. aruanense, and C. piscicola); pharynx approximately at level of the corner spines (vs. pharynx far anterior to corner spines in C. brasiliense, C. aruanense, and C. piscicola); and testes ovoid and nonoverlapping (C. aruanense; vs. sinuous and overlapping in C. brasiliense and C. piscicola). Based on our results, we revise the diagnosis of CaballerotremaPrudhoe, 1960 to include features associated with the shape and distribution of body surface spines, orientation and position of head collar spines, cirrus sac, seminal vesicle, oviduct, Laurer's canal, oötype, vitellarium, and transverse vitelline ducts. We performed Bayesian inference analyses using the partial large subunit ribosomal (28S) DNA gene. Our 28S sequence of C. annulatum was recovered sister to that of Caballerotrema sp. (which is the only other caballerotrematid sequence available in GenBank) from an arapaima, Arapaima gigas (Schinz, 1822) (Osteoglossiformes: Arapaimidae) in the Peruvian Amazon. Our sequence of C. annulatum comprises the only caballerotrematid sequenced tethered to a morphological description and a voucher specimen in a lending museum. The present study is a new host record and new locality record for C. annulatum. The phylogeny comprises the most resolved and taxon-rich evolutionary hypothesis for Echinostomatoidea published to date.

Omphalomesenteric Ducts and Urachal Remnants: A Retrospective Study and Case Series.

The management strategies for umbilical disorders remain undefined. This study aims to review our experience and propose a management algorithm for symptomatic urachal and omphalomesenteric duct anomalies. We retrospectively reviewed medical charts between January 2013 and September 2017 of 28 patients with clinical concern for umbilical disorders, out of which 10 were diagnosed with omphalomesenteric duct remnants (OMDR) or urachal remnants (UR). We assessed patients' sex, age at operation, initial presentation, imaging findings, surgical approach, histopathological findings, and prognostic outcome. Among 10 patients with OMDR or UR, initial presentations were omphalitis in four, umbilical discharge in three, abdominal pain in two, and umbilical mass in one. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and voiding cystourethrography were performed in 10, seven, three, and four patients, respectively. Transumbilical extraperitoneal excision from a small expanded umbilical incision and laparoscopic approach combined with transumbilical excision was performed in eight and two patients, respectively. Postoperative wound infection occurred in 10% of patients. Ultrasonography was mostly used as an initial diagnostic modality, and in cases in which there were signs of infection, they were drained adequately; CT/MRI was chosen for further evaluation of suspicious cases for other complications. Thus, we recommended surgical excision in cases with persistent umbilical disorders. The umbilical approach displays good cosmetic results with easy, complete excision, and the laparoscopic approach could be an excellent diagnostic and therapeutic method for the management of complicated conditions.

Ectopic "Ectopic" Gastric Mucosa.

Meckel's diverticulum is a developmental GI anomaly. It is a remnant of the omphalomesenteric duct (vitelline duct) and the most common congenital anomaly found in the small intestine. It contains ectopic/heterotopic gastric mucosa in half of the cases. Imaging investigations for diagnosing Meckel's diverticulum may include a plain radiography; however, this has a very limited diagnostic value. A blind-ending fluid-filled structure can sometimes be seen with sonography, but again, this technique's diagnostic value is limited due to multiple factors. A CT scan may be helpful in localizing the bleeding diverticulum, which can be better visualized with CT enterography. Diverticula containing gastric mucosa can be diagnosed with a higher sensitivity with Tc-99 scintigraphy. The typical location of Meckel's diverticulum is within two feet of the ileocecal valve; thus, ectopic gastric mucosal uptake is typically seen in the lower right quadrant in scintigraphy. We present a rare case of Tc-99 pertechnetate scintigraphy showing ectopic gastric mucosa in the upper mid abdomen, which was surgically proven to be at the mid ileum. To our knowledge, there is no ectopic Meckel's diverticulum case published in the literature. Familiarity with this atypical imaging presentation of relatively common ectopic gastric mucosa may help the radiologists in the timely diagnosis and management of the patient.

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.

Bowel obstruction secondary to a remnant of the omphalomesenteric duct: A case report

Introducción. El remanente del conducto onfalomesentérico corresponde a una malformación congénita relacionada con defecto en el cierre del saco vitelino. Su presentación en la adultez es infrecuente y se relaciona con múltiples complicaciones abdominales. El objetivo de este artículo fue presentar el caso de un paciente con obstrucción intestinal secundaria a la persistencia del conducto onfalomesentérico. Caso clínico. Se presenta el caso de un paciente de 19 años, con clínica de obstrucción intestinal y hallazgos tomográficos que sugerían una zona de transición en asas intestinales delgadas, por lo que se llevó a cirugía. Resultados. En la laparoscopia exploratoria se encontró una banda fibrótica firmemente adherida al intestino delgado y la pared abdominal, configurando una hernia interna, que condicionaba obstrucción intestinal y gran dilatación de las asas, por lo que se decidió convertir a laparotomía. Se resecó la estructura descrita sin complicaciones y el paciente evolucionó satisfactoriamente. El reporte de patología informó un remanente del conducto onfalomesentérico. Conclusiones. La persistencia del conducto onfalomesentérico es una causa infrecuente de obstrucción intestinal en el paciente adulto; sin embargo, es importante tenerlo presente dentro de los diagnósticos diferenciales de obstrucción intestinal y realizar estudios histopatológicos confirmatorios.

Persistence of the omphalomesenteric duct in adults: Case report and literature review

Introduction: Multiple pathologies can affect the umbilical cord, either due to infectious causes or malformation causes (acquired or congenital). However, the persistence of the omphalomesenteric duct and the urachus are the most frequent congenital malformations, especially in the pediatric setting, but not in the case of adults. Case report: The case of a 68-year-old male patient from a rural area, a farmer, with an enterocutaneous fistula, who received surgical treatment, is presented. He went to the consultation due to yellowish fluid leaking from the umbilical region, pain, and erythema, with a history of prostatectomy, osteoarthritis, and arterial hypertension. He was admitted with a diagnostic impression of cellulitis vs wall abscess. According to the assessment by the surgical team, a clear discharge of intestinal fluid was observed through the navel, for which reason emergency surgical resolution was decided for exploratory laparotomy. The patient reports discharge of yellowish fluid from the navel since childhood; there is a high suspicion of a picture compatible with the persistence of the omphalomesenteric duct in the adult. The patient underwent surgery with the following finding: A fully patent omphalomesenteric duct (enteroumbilical fistula) was found 70 cm from the ileocecal valve, plus incidental appendectomy. He was discharged on the eighth day of hospitalization, with a favorable evolution, outpatient treatment, and outpatient control. In addition, a bibliographical review in scientific databases such as Pubmed, Scopus, Proquest, Lilacs, Scielo, and Google Academic. Conclusions: surgical treatment with a favorable evolution, outpatient treatment, and outpatient control

Fetal external features and morphology of the umbilical cord of wild boars.

This study aimed to describe the gestational and morphological aspects of the fetuses and their respective umbilical cords from two pregnant wild boars (Sus scrofa). Morphological descriptions were provided for 23 fetuses and the gestational ages were estimated through fetal characteristics and formula application. The specimens were fixed in 10% formalin for subsequent macroscopic and microscopic examination. Histological characterization was performed using haematoxylin-eosin (H&E), Masson's trichrome (MT) and Verhöeff's staining techniques. The wild boar fetuses exhibited an estimated gestational age of 55 days (in the larger uterus) and 45 days (in the smaller uterus). They displayed well-developed features consistent with domestic pig fetuses, except for the presence of five pairs of mammae. Additionally, the umbilical cord consisted of two arteries, one vein, an allantoic duct, and a vitelline duct (the latter two identified only microscopically), located in the juxtafetal, intermediate and juxtaplacental portions. The arteries and veins were comprised of endothelium, smooth muscle and collagen fibres, with no elastic fibres observed in the vessel walls. The allantoic duct was lined with simple cuboidal epithelium, while the vitelline duct featured a simple squamous epithelium. In conclusion, the morphological characteristics observed in the examined structures align with the expected patterns for species of the Suidae family. Furthermore, these findings contribute substantially to the morphological characterization of the wild boar, yielding valuable insights into the fetal morphology and the structure of the umbilical cord.

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.

Diverticule de Meckel : une cause rare d’occlusion intestinale aiguë

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract [1]. It results from incomplete obliteration of the vitelline (omphaloenteric) duct. Observed diverticulum complications include inflammation and perforation, hemorrhage and obstruction. [2]We are reporting on a case of Meckel’s diverticulum revealed by acute intestinal obstruction.

The incidence, gross and histological features of Meckel’s diverticulum: A cadaveric study

: Meckel’s diverticulum (MD) develops from persistent omphalomesenteric duct and is an uncommon finding in females. Our aim is to report the incidence of finding of MD in cadavers and to study its gross and histological feature. : The observational study was conducted in 60 cadavers over a period of nine years. In the present study a meckel’s diverticulum was detected in sixty years old female cadaver. : The diverticulum was 63 cm proximal to ileocecal junction. It was 6 cm in length and 3.5cm in width and its tip free from any connections. Histologically, it showed four layers of ileum and patchy areas of coagulative necrosis in the mucosa.: These uneventful Meckel’s diverticulum findings of meckel’s diverticulum should be reported from time to time in particular population which may be beneficial for the surgeons and radiologists.

Meckel's diverticulum: A rare cause of acute intestinal occlusion

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract [1]. It results from incomplete obliteration of the vitelline (omphaloenteric) duct. Observed diverticulum complications include inflammation and perforation, hemorrhage and obstruction. [2]We are reporting on a case of Meckel’s diverticulum revealed by acute intestinal obstruction.

An atypical presentation of a patient with a combination of omphalomesenteric duct-related anomalies: A case report

The omphalomesenteric duct is an embryonic structure which connects the yolk sac to the midgut. The omphalomesenteric duct attenuates between the 5th and 9th week of gestation. Failure of the omphalomesenteric duct involution, either partial or complete, results in various omphalomesenteric duct remnants including Meckel's diverticulum, patent vitelline duct, fibrous band, sinus tract, umbilical polyp and cyst. Omphalomesenteric duct remnants are present in 2% of the population but related diseases have seldom been reported in children. We present a case of a 12 years old boy there was coexistence of the previously mentioned anomalies of the omphalomesenteric duct (Meckel's diverticulum, sinus and cyst). To our knowledge, our case is the first pediatric case with the coexistence of the previously mentioned anomalies of the omphalomesenteric duct.

Ileal prolapse through patent omphalomesenteric duct in a two year-old boy: a case report

BackgroundPatent omphalomesenteric duct is one of the birth defects included in the spectrum of vitelline duct abnormalities. It is a rare anomaly with estimated prevalence of 0.13–0.2% in the general population. The most common presentation of patent vitelline duct is yellowish or mucoid type umbilical discharge which is usually noted in neonatal age or infancy. The main stay of diagnosis is clinical and outcome is favorable as long as timely surgical correction is offered. Here we present a 2 years old male child who presented with ileal prolapse through patent vitelline duct which is an exceptional mode of presentation of this pathology.Case presentation2 years old Ethiopian male child who was noticed to have umbilical discharge since early infancy presented with protrusion of pinkish mass per the umbilicus of 4 h duration. He had no signs and symptoms of bowel obstruction. Abdominal examination revealed a prolapsed bowel which was viable via the umbilicus which was about 6 cm long. Otherwise, he had no abdominal tenderness or rigidity. He was explored with a smiley incision just above the umbilicus. The prolapsed bowel was reduced gently to the abdominal cavity. The tract of the Patent vitelline duct was identified and completely resected along with a wedge of ileum at its base. Primary repair of the ileal end where the tract was inserted was done in two layers and abdomen was closed in layers. The child had smooth post op course and was discharged on the 4th post-operative day.ConclusionProlapse of a bowel through the umbilicus is unusual presentation of a rare anomaly namely patent vitelline duct. This presentation warrants early surgical intervention before bowel ischemia issues. Hence, all clinicians dealing with children should be aware of this rare pathology so that urgent surgical management can be offered.

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.

Patent vitellointestinal duct with ileal prolapse in a newborn: A case report and literature review.

Patent vitellointestinal duct is the most common omphalomesenteric duct anomaly to present with symptoms. A 10-day-old child presented with increase in the size of a polypoidal lesion into a large, "Y"-shaped reddish, prolapsing lesion, discharging gaseous, and fecal matter at her umbilicus. A laparoscopic exploration was performed, followed by wedge resection and anastomosis. No complications occurred during postoperative follow-up. A patent vitellointestinal duct with ileal prolapse. The resection of extended intraperitoneal intestinal tube was performed. During the follow-up 3 months after surgery, the umbilical cord of the child healed well after surgery. Timely surgical treatment can minimize the occurrence of complications, and the overall prognosis is good after surgery.