Patent Vitellointestinal Duct Research Articles

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.

Cosmetic Results in Transumbilical Resection of Patent Vitellointestinal Duct in Infants.

Cosmetic Results in Transumbilical Resection of Patent Vitellointestinal Duct in Infants.

Patent Prolapsed Vitellointestinal Duct in Neonate: Sonographic and Magnetic Resonance Evaluation

Omphalomesenteric duct can result in various forms of anomalies due to the failure of its absorption. Various presentations can be in the form of patent vitelline duct, Meckel’s diverticulum, sinus tract, fibrous band, umbilical polyp prolapsing over the umbilicus or enteric fistula. It is important to diagnose these various anomalies in neonates with ultrasonography (USG) and magnetic resonance imaging (MRI) which are radiation free modalities. We present the case of a 20-day-old male baby who was having partial intestinal obstruction, umbilical discharge and slight herniated content from the umbilicus. The neonate underwent USG and MRI studies and was diagnosed with prolapsed vitellointestinal duct. In general, diagnosis of patent prolapsed vitellointestinal duct is difficult on clinical examination on the first look. USG and MRI help in the confirmation of the diagnosis as the anatomical details are well delineated by these modalities and in addition to being radiation hazards-free. This helps in early management as these types of pathologies can lead to many fatal complications.

Modified circumumbilical approach for duodenal atresia repair : A scarless surgery

Background: Duodenal atresia is a common congenital anomaly causing neonatal intestinal obstruction. The definitive treatment is to restore the intestinal continuity. Laparotomy via upper transverse abdominal incision has been described by many authors as a standard approach for duodenal atresia repair. Here we report a case of newborn underwent duodenal atresia repair via modified circumumbilical approach with satisfactory postoperative outcome. Case presentation: This is a case of premature baby boy, born at 32-week gestation with a birth weight of 1.5kg. Antenatally he was detected to have double bubble sign which was confirmed upon postnatal abdominal radiograph, suggestive of duodenal atresia. He was noted to have a fleshy lump at the umbilicus presumed to be a patent vitello-intestinal duct from the referring hospital. Subsequently he developed umbilical swelling suspicion of umbilical hernia with incarceration and scheduled for emergency umbilical exploration. A circumumbilical incision was made and found to have an umbilical defect with omental herniation, instead of a patent vitello-intestinal duct. A proximal midline incision was made as an extension to the circumumbilical wound enabling a duodenal kocherization and subsequently had duodeno-jejujonostomy anastomosis for the duodenal atresia repair. Postoperative recovery was uneventful with appealing cosmesis. Conclusion: A modified circumumbilical incision is an attractive alternative approach for a duodenal atresia repair. Apart from its cosmetic advantage, the approach provides adequate exposure for similar outcome with transverse abdominal incision.

Effects of Methimazole vs Propylthiouracil in Newborns: A Comparative Review.

Hyperthyroidism is more common in women and the sensitivity of thyroid function changes during pregnancy. Excess levels of thyroid hormones and thioamides have a major impact on maternal and fetal outcomes. Our aim was to perform an extensive literature review and provide relevant details concerning the analytical and clinical aspects of the potential effects of the two main drugs used (methimazole and propylthiouracil) in newborns. A thorough literature review was conducted using PubMed and Google Scholar databases. In total, 10 relevant studies were identified and data from these studies were extracted and then extrapolated into results after analysis. Three out of four studies that used methimazole and carbimazole, one and two, respectively, showed adverse fetal outcomes requiring surgical management for congenital anomalies like aplasia cutis, patent vitellointestinal duct, and gastroschisis. Out of the three studies that used propylthiouracil, one baby underwent surgery for bilateral pyelectasis, vesicovaginal fistula, anal stenosis, and polydactyly. The findings of the aforementioned studies provide enough evidence to imply that the use of methimazole and carbimazole to treat antenatal hyperthyroidism has worse fetal outcomes than the use of propylthiouracil. Also, given the paucity of data in the existing literature regarding propylthiouracil's effects on newborns, further studies in this demographic are needed.

VERY RARE COMBINATION OF PATENT VITELLOINTESTINAL DUCT WITH PATENT URACHUS

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

Next Generation Sequencing in Vitellointestinal Duct Adenoma: Existence of Adenoma-Carcinoma Sequence or too Early to Predict?

Patent vitello-intestinal duct with adenoma is rare presentation. We report a case of a 1-month-old boy presenting with intermittent passage of stool and blood from the umbilicus since birth. On local examination polypoidal mass measuring 1×1 cm was seen protruding from umbilicus with faecal discharge. Ultrasound was performed which revealed a tubular hyperechoic structure, extending from umbilicus to part of small intestine measuring 30 ×30 mm and clinical diagnosis of patent vitello-intestinal duct was given, exploratory laparotomy, excision with umbilicoplasty done, and send for histopathological examination. On histopathological examination, patent vitello-intestinal duct adenoma was rendered and next generation sequencing (NGS) was performed revealing somatic mutation of KRAS (NM_033360.4; c.38G>A; p.Gly12Asp). To our knowledge, this is the first report of the adenoma in patent vitello-intestinal duct with NGS analysis. This case emphasizes the importance of thorough microscopic examination of resected patent vitello-intestinal duct and mutational analysis of the early lesions.

Distinct presentations and management of hernia of the umbilical cord: 15 years’ experience in a tertiary hospital

BackgroundHernia of the umbilical cord (HUC) is an uncommon type of abdominal wall defect characterized by a hernia of the midgut into the proximal section of the umbilical cord. This is occasionally coupled with other congenital abnormalities. This is frequently misdiagnosed and referred to as “omphalocele minor.” In certain cases, unintentional cord clamping causes iatrogenic intestinal harm. The purpose of this retrospective study is to highlight various aspects of the HUC therapy in 30 patients with typical and unusual presentations in a tertiary care facility as well as intraoperative findings and associated abnormalities.MethodsThirty neonates (21 males and 9 females) with usual and unusual presentations of HUC diagnosed and treated at the King Abdelaziz University Hospital, Jeddah, Saudi Arabia, over 15 years period from 2005 to 2020.ResultsOut of 30 cases included, 17 patients were reducible with simple classical HUC repair. While 13 patients had different presentations, six cases presented with irreducible content due to variable reasons, four cases presented with patent vitellointestinal duct (PVID), 2 cases presented with intestinal obstruction, and one case presented late with epithelialized HUC sac.ConclusionsAttention to HUC should be paid by obstetric professionals in order not to miss it on antenatal ultrasound and careful umbilical cord examination at delivery to avoid clamping of visceral content if present in HUC.

Congenital hernia of umbilical cord with patent vitellointestinal duct along with evisceration of gut\u2014a rare presentation and unusual management

BackgroundCongenital hernia of umbilical cord is a rare congenital anomaly. Due to its presentation as herniation of small bowel or other viscera into the umbilical cord, it is often misdiagnosed as omphalocele minor.Case presentationWe are reporting a rare case of congenital hernia of umbilical cord which presented with rupture of hernia sac and evisceration of small bowel loops with reverse ileal intussusception via a patent vitellointestinal duct. It was managed by first repositioning the gut with stoma at umbilical site as a temporizing measure followed by definitive surgery in the form of resection of patent vitellointestinal duct and end to end ileal anastomosis.ConclusionCongenital hernia of umbilical cord with patent vitellointestinal duct is a rare abdominal wall defect which can present beyond neonatal period with evisceration of gut. A high index of suspicion should be kept by the first attending clinician to avoid a delay in management.

Inverted ileal loop prolapse through patent vitellointestinal duct

Patient vitellointestinal duct (VID) is not very common because of its varied presentation and complication, and the prolapse of an inverted ileal loop through patent VID is an extremely rare presentation. Here, we report a case of a 4-month-old boy of patent VID through which distal half of the inverted ileal loop got prolapsed, appearing as Y loop. Emergency laparotomy was done. The ileal loop was reduced and resection anastomosis of the involved ileal segment was performed.

\u201cType C appendicular duplication with patent vitello-intestinal duct\u2014an unforeseen association\u201d\u2014a case report

BackgroundGastrointestinal duplications are uncommon occurring in 1 in 5000 live births. Small intestine is commonly involved, while appendicular duplications are extremely rare. Vitelline duct anomalies arise due to failure of involution of the omphalomesenteric duct. Their spectrum ranges from a simple umbilical sinus to completely patent omphalomesenteric fistulae. We report here a rare association of complete appendico-cecal duplication with patent vitello-intestinal duct (PVID).Case presentationA 14-year-old girl who presented with complaints of scant, foul smelling, and feculent discharge from umbilicus intermittently since birth was evaluated and diagnosed to have a patent vitello-intestinal duct. At laparotomy, a patent vitello-intestinal tract opening unusually at the ileo-cecal junction was noted. In addition, an appendico-cecal duplication cyst bearing an appendix on the mesenteric side and a 4-cm long orthotopic appendix on the native cecum was found with the duplex cecum sharing a common wall and blood supply. The terminal ileum with the duplication and patent vitello-intestinal duct were excised in toto, and an end-to-end ileo-ascending anastomosis was done. The child is well at 1 year follow-up.ConclusionA complete appendico-cecal (Type C) duplication with ectopically inserted patent vitello-intestinal duct is reported here as an unusual association, discussing its management and the probable disarray in the embryological development.

A CASE REPORT VITELLO-INTESTINAL DUCT FISTULA – A RARE PRESENTATION OF A PATENT VITELLO-INTESTINAL DUCT.

Patent Vitello-Intestinal Duct (VID) results as of failed obliteration of the fetal omphalocele coelom (herniated loops of intestine in the umbilical cord) during the development of the midgut. Herein, we report a case of a male child who presented at 5 year of age with history of persistent fecal discharge from umbilicus since birth.The VID stula was conrmed with a ultrasound and a wedge resection with primary anastomosis was done for it. The child was discharged 5 days postop without any complications. This case report highlight a rare cause of umbilical discharge for which surgical intervention was required.

Patent vitellointestinal duct presenting as an umbilical abscess: a novel operative approach to a rare adult presentation.

Patent vitellointestinal duct presenting as an umbilical abscess: a novel operative approach to a rare adult presentation.

Management of Patent Vitellointestinal Duct in Infants

Abstract Objectives This study was undertaken to investigate and review the clinical presentation, surgical procedures executed, and the final outcome of infants managed for the patent vitellointestinal duct. Materials and Methods This is a single-institution, retrospective study and included infants who were operated for the patent vitellointestinal duct. This study was conducted at author’s Department of Paediatric Surgery during the last 20 years; from January 1, 2000 to December 31, 2019. Results A total of 24 infants were operated for the patent vitellointestinal duct during the study period and comprised 20 (83.3%) boys and 4 (16.6%) girls. The age of infants ranged from 7 days to 10 months, with a mean of 88.41 ± 64.9 days. Twenty-three (95.8%) infants were operated within 6 months of the age, 17 (70.8%) of them were operated within 3 months of the age. Only one (4.1%) infant was operated at the age of 10 months. Among 24 infants, 13 (54.1%) were presented with features suggestive of acute intestinal obstruction and remaining 11 (45.8%) were presented with fecal discharges through the umbilicus without intestinal obstruction. Among 13 infants who presented with acute intestinal obstruction, 12 had prolapsed bowel and 6 of them also had gangrenous bowel. Operative procedures were executed (n = 24) in the following order of frequency: (1) resection of patent vitellointestinal duct, wide wedge resection of ileum,and ileal repair (n = 13, 54.1%); (2) resection of patent vitellointestinal duct, small segment of ileum, and ileoileal anastomosis (n = 9, 37.5%); and (3) resection of patent vitellointestinal duct, segment of ileum, and an ileostomy (n = 2, 8.33%). Postoperatively, two (8.3%) infants developed anastomotic leak and peritonitis one each, later on, both of them died. Conclusion Patent vitellointestinal duct not only present with fecal discharges through the umbilicus but half of the infants presented with prolapsed bowel and with features of acute small bowel obstruction. Delay in seeking treatment for such cases was associated with considerable morbidity and mortality and therefore the patent vitellointestinal duct should be excised at the earliest.

WITHDRAWN: Hirschsprung disease masquerading as patent vitello-intestinal duct

Abstract Hirschsprung disease (HD) is usually presented early in the neonatal period with delayed or no passage of meconium up to 48 hours, with abdominal distension and bilious vomiting. A 3-month-old baby boy with a history of neonatal asphyxia presented a 2-week duration of umbilical redness and a foul-smelling greenish discharge. He was treated for omphalitis and was given oral antibiotics, but later developed feeding intolerance and abdominal distension with no bowel opening. The abdomen was grossly distended, tense with erythematous umbilicus, and a greenish discharge from the umbilical punctum. A plain abdominal radiography showed dilated bowels. With the impression of complicated patent vitello-intestinal duct, the baby was subjected for an emergency laparotomy. Intraoperatively, there was a grossly dilated and inflamed sigmoid colon with a 5 mm perforation on the sigmoid colon. It formed a direct communication to the umbilical defect, forming a colo-umbilical fistula. The perforation site was resected and brought out as a sigmoid colostomy. The resected perforation site showed an acute inflammation with the presence of ganglionic cells, histologically. Since HD is highly suspicious, a suction rectal biopsy was performed postoperatively and revealed typical features of HD. Subsequently, the patient underwent the Duhamel procedure; the stoma was brought down and anastomosed with the anal canal. Despite the typical presentation of HD, it can also present enterocolitis, and to some extent, a bowel perforation. In this case, we were fortunate that the bowel perforation formed a direct fistulation to the umbilicus, instead of free perforation inside the peritoneal cavity, causing peritonitis or a less favourable outcome.

Differentiation Between Umbilical Granuloma and Patent Vitellointestinal Ducts in Infants and its Associated Complications- 8 Years Retrospective Study: Novel Approach

Umbilical granuloma is a very common cause of umbilical discharge. It is managed by chemical cauterization, Bipolar electric cauterization and sometimes by simple thread ligation. However, it must be differentiated from omphalo-mesenteric remnants otherwise it can lead to disastrous complications like prolapsed of ileum and subsequent gangrene of bowel. Ultrasonography is very important tool for differentiation between umbilical granuloma and ramnants of viltello-intestinal ducts or urachus. 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 patients.

Varied clinical presentation of Meckel’s diverticulum in pediatric population

Background: Meckel’s diverticulum (MD) is one of the most prevalent congenital abnormalities of the small intestine. Due to its wide-ranging presentations, it often becomes a challenge to diagnose it. Objective: The objective of the study is to analyze varied clinical manifestations of MD in children and their outcomes. Materials and Methods: This was a retrospective study of children diagnosed with MD in the Department of Pediatric Surgery, Medical College of Karnataka from January 2015 to January 2019. A total of 13 patients (10 male and 3 female) aged 1 month–15 years with a diagnosis of MD were included in the study. Their demographic and clinical parameters, investigation, and histopathological findings along with the surgical interventions were collected and analyzed. Results: Patients were presented with varied clinical features such as intestinal obstruction (30.76%), perforated MD (15.38%), diverticulitis (15.38%), gastrointestinal bleed (7.69%), patent vitellointestinal duct (7.69%), and incidental (23.07%). All the cases were investigated and underwent treatment. The most common post-operative complication was wound infection in 2 children which were treated conservatively. Conclusion: A pre-operative diagnosis of complicated MD may be challenging because of the overlapping clinical and imaging features of the other acute surgical and inflammatory conditions of the abdomen. Therefore it is necessary to maintain a high incidence of suspicious in the pediatric age group.

Patent Vitellointestinal Duct Presenting as a Paraumbilical Abscess Along with Intestinal Obstruction in an Adult: a Case Report

The persistence of embryonic vitelline duct occurs in about 2% of the population. Patent vitellointestinal duct (VID) is a rare condition in adults. This anomaly may remain asymptomatic throughout life or may present with umbilical sinus, abscess, fistula, intussusception, and various other intraabdominal complications. We present here an interesting case of 32-year-old man with patent VID presenting as paraumbilical abscess along with intestinal obstruction caused by marked inflammatory changes and adhesion. This patient was managed successfully with excision of the entire duct along with the wedge of ileal attachment. Such rare presentation in an adult has not been reported earlier to the best of our knowledge. Simple incision and drainage of abscess without excision of patient VID would not result in complete treatment of this condition. Therefore, surgeons and radiologists should have high index of suspicion of this uncommon presentation as it is likely to be missed.

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.

Patent Vitello-Intestinal Duct: A Misdiagnosis of Persistent Umbilical Granuloma

Patent vitello-intestinal duct (VID) is a rare embryological defect. Pre-operative diagnosis may be difficult to be made by primary physicians and misdiagnosed as umbilical granuloma. We report a 24-day-old girl with repeated attempts of silk-tie ligation in primary care as she presented with a persistent umbilical mass with discharge. On referral to tertiary pediatric surgical center, diagnosis of patent VID was made, and umbilical exploration with bowel resection was performed. The patient was asymptomatic after the definitive surgery.