Patent Vitellointestinal Duct Research Articles

A rare confounder in a case of ovarian torsion

We report a 26-year-old woman who presented to the Emergency Department in late 2011, with severe right iliac fossa pain, nausea and vomiting after two weeks of mild generalised abdominal pain. There was no history of fever, urinary symptoms, vaginal bleeding or discharge, or change in bowel habit. Apart from a previously diagnosed right ovarian cyst, her past medical and surgical histories were unremarkable. The cyst had been noted incidentally on a routine ultrasound in 2006 and measured 6.49 cm in diameter. It was simple in nature, unilocular and anechoic. The patient had been having annual follow-up with ultrasound surveillance. Due to the cyst’s lack of increase in size and its asymptomatic nature, the patient opted against surgical intervention. Her obstetric history consisted of two successful spontaneous vaginal deliveries in 2005 and 2006. She was not on any medications, had no known allergies and was a non-smoker. On physical examination, there was localised tenderness and involuntary guarding in the right iliac fossa. Vaginal examination revealed mild right adnexal tenderness and cervical excitation tenderness. No blood or purulent fluid was noted in the cervical os. Laboratory investigations revealed a leucocytosis (13.4 109/ L; normal range 4.0–11.0 109/L), predominately neutrophils (10.28 109/L; normal range 2.0–8.0 109/L). Biochemistry was normal. b-Human chorionic gonadotropin (bHCG) was negative and urinalysis normal. Transabdominal ultrasound revealed a thin-walled simple anechoic cyst involving the inferior pole of the right ovary, measuring 6 cm in diameter, with a trace of adjacent free fluid. Colour Doppler flow was seen within the right ovary. The uterus and left ovary were normal. The appendix was not visualised. Differential diagnoses included appendicitis, ruptured right ovarian cyst, ectopic pregnancy, right ovarian torsion and pelvic inflammatory disease. Diagnostic laparoscopy was performed. A right ovarian torsion was identified, with the ovary tangled around a fibrous intraperitoneal band connecting the terminal ileum to the anterior abdominal wall at the level of the umbilicus (Fig. 1). The right ovary did not appear necrotic in appearance. The fibrous intraperitoneal band was then excised. The right ovarian cyst was then punctured, drained and stripped from the ovary, preserving the ovary. Post-operative recovery was unremarkable and the patient was discharged the following day. Histopathological examination of the band was consistent with an obliterated vitello-intestinal duct, persisting as a fibrous intraperitoneal band. The cyst was consistent with an ovarian cystadenoma. The vitello-intestinal duct conveys nutrients from the yolk sac to the foetus during the first eight weeks of gestation, after which it normally disappears. Persistence of the vitellointestinal duct results in various types of anomaly [1]. Most commonly seen is a Meckel’s diverticulum, while others include a patent vitello-intestinal duct, fibrous intraperitoneal band, umbilical sinus or vitello-intestinal duct cyst [2]. The commonest complication of the fibrous intraperitoneal band is usually an intestinal obstruction [3]. Unilateral ovarian torsions occur most commonly in relation to previous pelvic surgery, ovarian cysts or neoplasms, or an elongated utero-ovarian ligament [4,5]. An extensive literature search of Ovid MEDLINE and PubMed did not reveal any prior publications of vitello-intestinal remnants causing ovarian torsion. In conclusion, a persistent vitello-intestinal duct anomaly causing right ovarian torsion is a rare occurrence. We believe this report constitutes the only such case in the English-language literature. The possibility of this rare diagnosis should be entertained when treating patients with ovarian torsion. It is also recommended that large ovarian cysts should be followed more carefully and if persistent, managed surgically in a controlled fashion to avoid such complications as haemorrhage or torsion.

Patent Vitellointestinal Duct: A Close Differential Diagnosis of Umbilical Granuloma: A Case Report and Review of Literature

Umbilical granuloma is a very common cause of umbilical discharge. It is managed by chemical cauterization or simple thread ligation. However, it can be a differential diagnosis of patent vitello intestinal duct and this should be ruled out before managing such patients. We report a case of a 10-week-old male infant referred by his General Practitioner for silver nitrate cauterisation, with a diagnosis of suspected umbilical granuloma (UG). The child underwent subsequent exploratory laparotomy and bowel anastomosis.

Suspected Spontaneous Reports of Birth Defects in the UK Associated with the Use of Carbimazole and Propylthiouracil in Pregnancy

The concept of a carbimazole embryopathy underlies current Endocrine Society advice to avoid this drug in early pregnancy, favouring propylthiouracil as an alternative for the treatment of maternal hyperthyroidism. We aimed to establish whether suspected spontaneous reporting of adverse drug reactions in the UK via the Yellow Card Scheme supports a carbimazole embryopathy and the lack of association between propylthiouracil and congenital anomalies. All birth defects related to maternal treatment with carbimazole or propylthiouracil reported over a 47-year period via the Yellow Card Scheme were analysed. 57 cases with 97 anomalies were reported following in utero exposure to carbimazole. These anomalies included aplasia cutis, choanal atresia, tracheo-oesophageal fistula, and patent vitellointestinal duct, which have previously been reported in association with carbimazole/methimazole exposure in utero. Only 6 cases with 11 anomalies were reported for propylthiouracil, all within the last 15 years. Therefore, these findings may support a carbimazole embryopathy. There are few birth defects associated with propylthiouracil, but this should be interpreted in the context of higher historical prescription rates for carbimazole.

Prolapse of bowel via patent vitello intestinal duct—a rare occurrence

This report describes the presentation of prolapse of small bowel through the patent omphalomesenteric or vitello intestinal duct in a child. In spite of diagnosing the anomaly earlier, there was delay in surgical intervention that led to prolapse of the small bowel through patent remnants, which was life threatening. The patient presented to us with questionable viability of prolapsed bowel. Early surgery is recommended for this entity. As this is a very rare occurrence, it is being reported with a brief review of the relevant literature.

Inverted ileal prolapse through patent Vitellointestinal duct: a case report

Inverted ileal prolapse through patent Vitellointestinal duct: a case report

Versatility of the circumumbilical incision in neonatal surgery

Following the advent of laparoscopic surgery, cosmesis has become an important factor in surgical decision making. The circumumbilical incision combines the advantages of an open approach with an aesthetically pleasing scar on the abdomen. The aim of this paper is to examine the results of this incision in neonatal laparotomy. All neonates who underwent a supraumbilical circumferential skin incision for an exploratory laparotomy in the period 1997-2007 were reviewed. Gestational age, operative procedure, conversions to standard laparotomy, complications and follow-up were recorded. A total of 55 neonates with a gestational age ranging from 28 to 42 weeks had 57 operative procedures. The indications were: nonrotation of midgut in 18; intestinal atresia in 18; necrotizing enterocolitis/spontaneous perforation in 10; meconium ileus in 5; intestinal duplication in 2; patent vitellointestinal duct (VID) in 2. No conversion to a standard transverse incision was necessary in any case. However, an omega extension was made in four patients. The complications encountered include wound infection in one; caecal perforation in one and incisional hernia in two cases. Subsequent follow-up revealed that all incisions had healed and the scars were almost imperceptible as affirmed by parental satisfaction during outpatient clinic consultation. The circumumbilical approach is a safe, flexible and easily reproducible approach providing adequate exposure for most abdominal surgeries in the neonate. The low complication rate and pleasing aesthetic outcome are much appreciated by parents and operators alike.

Carbimazole embryopathy‐bilateral choanal atresia and patent vitello‐intestinal duct: A case report and review of literature

In utero exposure to carbimazole for maternal hyperthyroidism has been reported to cause choanal atresia. There are case reports of patent vitello-intestinal duct and Meckel's diverticulum in similar association. We report another such instance of an infant who was exposed to carbimazole in utero, presenting with bilateral choanal atresia and patent vitello-intestinal duct. As there seems to be no reports of a possible association between propylthiouracil and congenital malformations, it may be safer to use propylthiouracil instead of carbimazole.

Symptomatic Meckel’s diverticulum in children: a 16-year review

Meckel's diverticulum (MD) has varied presentations and often becomes a diagnostic challenge. The purpose of this study was to review the various presentations of symptomatic MD and to assess the sensitivity of the Meckel's scan as a diagnostic tool in patients with bleeding MD. The hospital records of 71 consecutive patients with a diagnosis of MD from 1990 to 2005 were retrospectively reviewed. The data was assessed for age at presentation, sex, clinical features, investigations performed, surgical intervention and histopathological findings. There were 71 patients with a diagnosis of MD (age 2 days-14 years). In eight patients, MD was an incidental finding at laparotomy. The remaining 63 patients were symptomatic and presented with various clinical features. Ten patients (15.8%) had clinical features of peritonitis; of these, six had perforated MD and four had Meckel's diverticulitis at laparotomy. Nine patients (14.2%) were diagnosed as intestinal obstruction, and at laparotomy, a Meckel's band was found to be the cause of the obstruction. Nine patients (14.2%) had a patent vitello-intestinal duct and presented with umbilical discharge. Thirty-five patients (55.5%) presented with episodes of bleeding per rectum or malaena. Ultrasound scans revealed intussusception in six patients requiring open reduction. Of the remaining 29 patients with bleeding per rectum, 27 underwent a Meckel's Tc99 scan that showed a positive tracer in 18 patients (66.6%) and negative in 9 (33.3%). All patients with a symptomatic MD underwent resection of the diverticulum. Histology revealed ectopic gastric mucosa in 43 patients (68.3%). MD has various presentations and can be easily misdiagnosed. It is necessary to maintain a high index of suspicion in the paediatric age group. The Meckel's scan has a poor positive predictive value and cannot be relied upon for a diagnosis in cases of bleeding MD if Tc99 scan is negative.

Absence of Wharton’s jelly around the umbilical arteries

Wharton's jelly is a specialized tissue which acts as supportive and protective structure substituting for the adventitia of the umbilical vessels. Absence of Wharton's jelly around the umbilical arteries is very rare and an unusual cause of perinatal mortality. We report a case of absent Wharton's jelly around the umbilical arteries with patent vitellointestinal duct--a rare association.

Patent vitellointestinal duct with prolapse of inverted loop of small intestine: a case report

A wide variety of anomalies may occur as a result of the vitellointestinal duct (VID) failing to obliterate completely. Most reports on symptomatic VID focus on Meckel's diverticulum, while other anomalies are given little attention. We report a case of a baby of five months who had an intestinal loop inverted through a patent VID. The inverted loop was reduced and ileostomy was done which was closed after 6 weeks.

Persistent umbilical discharge in infants and children

Umbilical discharge is not an unusual presentation in infants and children. However, the evaluation and management are rarely discussed. A retrospective review of 18 patients presenting with persistent umbilical discharge over a period of 22 years, excluding neonates with omphalitis. The patients' ages ranged between 11 days and 9 years. Presentation was usually discharge of clear, serous or purulent fluid or faecal matter from the umbilicus, sometimes dating back to the neonatal period. Evaluation consisted of bacteriology, fistulogram (one patient) and histopathology. The cause of discharge was patent vitello-intestinal duct in 11 patients, umbilical granuloma in three, umbilical sinus in two and patent urachus and osteomyelitis of the ischium in one each. Definitive treatment was exploration and complete excision of the lesion and antibiotics. Two patients with patent vitello-intestinal duct died, one before surgery from hypokalaemia and sepsis, and the other from anaesthetic complications. There is a need for early referral and treatment in patients with persistent umbilical discharge. Conservative treatment is usually not successful as the common causes would normally require complete excision.

Congenital intestinal fistula with exomphalos minor

Minor degrees of exomphalos have been known to be associated with vitellointestinal duct anomalies. The most frequent association is Meckel's diverticulum. It is unusual for a fistula to be communicating directly with the exomphalos sac. We report five neonates that presented with a fistula on the exomphalos sac over a 10-year period. The different variants of patent vitellointestinal duct in these cases have been discussed with a review of the literature.

Cytokine response of neonates to surgery

Cytokines are early responders in the cascade of host mediators after injury. The cytokine response in neonates following surgery and its prognostic significance were studied prospectively. Twenty-one patients (oesophageal atresia [5], congenital diaphragmatic hernia [4], exomphalos [4], patent vitellointestinal duct [1], anorectal anomaly [2], choledochal cyst [1], renal cyst [1], ovarian cyst [1], myelomeningocoele [1], and pyloric stenosis [1]) operated on at a median age of 3 days (range, 1 to 24 days) and 12 age-matched controls were included in the study. Plasma samples were obtained once in the controls, and serially preoperatively and at 1, 3, 6, 12, 24, 36, and 48 hours postoperatively in the patients. The levels of the cytokines, interleukin-6 (IL-6), and interleukin-8 (IL-8) were measured using the enzyme-linked immunosorbent assay (ELISA) technique. The median plasma levels of IL-6 and IL-8 in normal controls were 2.4 pg/mL and 92.0 pg/mL, respectively. Of the 21 patients, four had postoperative complications (pulmonary consolidation [2], septicaemia [1], and oesophageal leak [1]) between days 4 and 6. All 17 uncomplicated cases had an increase in IL-6 and IL-8 in the early postoperative period, with the peak occurring within 12 hours after surgery. The mean (±SEM) peak levels of IL-6 and IL-8 in uncomplicated cases were of 92.6 ± 15.8 pg/mL and 230.3 ± 45.3 pg/mL, respectively. In the four complicated cases, there was a disproportionately higher increase in both IL-6 (peaks, 305.0, 125.0, 240.0, and 220.0 pg/mL) and IL-8 (peaks, 1500.0, 340.0, 245.0, 355.0 and pg/mL), which preceded the clinical onset of complications. The early postoperative increases in plasma IL-6 and IL-8 probably represent the stress response of neonates to surgery. Furthermore, the association of an exaggerated increase in postoperative levels of plasma IL-6 and IL-8 and postoperative complications may have prognostic significance.

Double intussusception of lleum through a patent vitello-intestinal duct: Report of the case and literature review: J.M. Benson and A.L. Sparnon. Aust N Z J Surg 62:411–413, (May), 1992

Double intussusception of lleum through a patent vitello-intestinal duct: Report of the case and literature review: J.M. Benson and A.L. Sparnon. Aust N Z J Surg 62:411–413, (May), 1992

Unusual presentation of patent vitello intestinal duct with round worms emerging from the umbilicus

Patient vitello intestinal duct (VID) is not an uncommon anomaly in children. It usually presents with fecal discharge from the umbilicus. Round worm infestation is very common in Indian children, but an association of patent VID and ascariasis, presenting as round worms emerging from the umbilicus, is unique and has not been previously reported in the literature. We present such a case in a 2-year-old boy who presented with a history of round worms coming out through the umbilicus. It was provisionally diagnosed to be a case of patent VID, which was proven correct on laparotomy.

Double intussusception of the small bowel through a patent vitellointestinal duct: R. Mustafa. Br J Surg 63:452, 1976

Double intussusception of the small bowel through a patent vitellointestinal duct: R. Mustafa. Br J Surg 63:452, 1976

Completely Patent Vitellointestinal Duct

To the Editor.— Completely patent vitellointestinal duct is rare.1The following case merits a brief report Report of a Case.— A male infant weighing 2.6 kg was delivered at full term on Dec 24,1974. The entire pregnancy and delivery were normal. When the umbilical cord sloughed off on the fifth day, there was a small red bud of tissue protruding from the navel. At the center of this mass, there was a minute opening from which a mucoid discharge was exuded. Subsequently, feces were discharged through the opening, and the periumbilical skin became inflamed. When he was 22 days old, the baby was admitted to the Bhumibol Adulyadej Hospital (Jan 14, 1975) with a diagnosis of completely patent vitellointestinal duct associated with moderate prolapse of its distal portion and periumbilical dermatitis. On admission, the infant showed a small, bright red, umbilical polypoid mass with a central fecal-draining

Patent omphalomesenteric duct--a surgical emergency.

IN THE early human embryo the alimentary canal communicates freely with the yolk sac. This channel is known as the omphalomesenteric duct and is also referred to as the vitellointestinal duct. The embryology is well described by Cullen. 1 As development proceeds, the duct becomes narrower and lies within the cord. Under normal conditions the duct disappears and the intestine has no connection with the yolk sac. Under abnormal conditions all, or any part, of the duct may persist, resulting in various anomalies as described by Benson 2 (Fig 1). In this paper we are concerned only with the situation in which there is complete patentcy of the duct (Fig 1 F ). This anomaly is often referred to as an umbilical enteric fistula as well as the more classic terms, patent omphalomesenteric duct or patent vitellointestinal duct. Diagnosis should not be difficult if the possibility of this anomaly is

Omphalocele with patent vitellointestinal duct and ileal prolapse: R. M. Davis and R. W. Kehm. Amer. J. Surg. 113:571–573, April 1967

Omphalocele with patent vitellointestinal duct and ileal prolapse: R. M. Davis and R. W. Kehm. Amer. J. Surg. 113:571–573, April 1967

Omphalocele with patent vitellointestinal duct and ileal prolapse

A successful repair of patent vitellointestinal duct and prolapse of the small bowel has been presented. Only with a surgical approach to cutaneous duct remnants can a physician be certain to exclude a patent vitellointestinal duct, Meckel's diverticulum, or potential obstructing band.