Persistent Omphalomesenteric Duct Research Articles

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.

Umbilical Discharge

An umbilical discharge is itself not a disease, but it is a symptom of many diseases. In children, it may be found to be associated with an underlying congenital abnormality like persistent OMD (Omphalo-mesenteric Duct) or Vitelline cysts or sinuses or umbilical granuloma or a diverticulum like the Meckel’s diverticulum which may possess ectopic gastric or pancreatic or even colonic mucosa, or the persistent allantois or a urachal cyst or an infected urachus etc. Umbilical discharge though rare in adults, it may be caused by diverse congenital or acquired conditions. The most common causes of umbilical discharge in adults are such acquired conditions as pilonidal sinus disease, infection of hair tufts and foreign bodies4, and specific and non-specific acute and chronic inflammation and abscess of the umbilicus, infected omphalolith etc. Very rarely the discharge may be due to endometriosis or metastatic carcinoma, umbilical hernia ulceration etc. Discharging umbilical abscess may be caused by bacteria that can enter as a result of penetrating trauma, rupture of the bowel, or abdominal surgery. Irrespective of aetiology, umbilical discharge is a distressing condition for the patient and the family members. Appropriate diagnostic aids and successful management strategies are now available. If not associated with malignant diseases or irreversible complications, the prognosis is excellent. KYAMC Journal Vol. 13, No. 01, April 2022: 50-55

Double ileoileal intussusception prolapse through persistent omphalomesenteric duct

Double prolapsed intussusception is a rare complication of persistent omphalomesenteric duct and it represents a surgical emergency. Any delay in its management may lead to a negative outcome. We report the case of a 6 week-old boy with intestinal necrosis due to a double ileum intussusception prolapse through a persistent omphalomesenteric duct. At the time of the presentation the infant had signs and symptoms of intestinal obstruction and intraoperatively intestinal necrosis on 25 cm of the double intussuscepted bowel was found. A resection of the ileum was performed followed by an end-to-end anastomosis with uneventful evolution and discharge on the 3rd postoperative day. We report a serious complication due to a delay in management of a persistent omphalomesenteric duct.

Intestinal obstruction caused by a clamped persistent omphalomesenteric duct in congenital hernia into the umbilical cord.

Intestinal obstruction caused by a clamped persistent omphalomesenteric duct in congenital hernia into the umbilical cord.

S2118 Angiographic Diagnosis and Treatment of Adult GI Bleeding from Meckel’s Diverticulum

INTRODUCTION: Meckel's diverticulum is the most common gastrointestinal anomaly resulting from a persistent omphalomesenteric duct. It is usually discovered in children when gastrointestinal (GI) bleeding occurs. This case demonstrates the use of provocative angiography for both the diagnosis and treatment of a bleeding Meckel's diverticulum in an adult. CASE DESCRIPTION/METHODS: A 22-year-old woman with no known past medical history presented to the emergency department with a chief complaint of black stool, lightheadedness and weakness. On exam, her abdomen was soft and non-tender. Rectal exam showed black stool with bloody mucus. Labs were significant for a Hgb of 6.1 (MCV 90.1) from 12.1 one week prior. During her hospitalization she underwent several studies to determine the location of her bleed. Esophagogastroduodenoscopy, colonoscopy, tagged red blood cell scan, and Meckel’s Scan were all normal. Video capsule endoscopy visualized blood in the terminal ileum and cecum mixed with stool, however no lesions were identified in these areas on colonoscopy. Magnetic resonance enterography was without evidence of small bowel inflammation. A visceral arteriogram was performed by interventional radiology, which was negative for bleeding until provocation was done using direct intra-arterial thrombolytic infusion (tissue plasminogen activator) that demonstrated active bleeding in an superior mesenteric artery branch which appeared to be serving a Meckel's diverticulum. Successful embolization was performed with a 3 mm coil and no further bleeding episodes occurred during her hospital stay. One month later she returned for surgical resection. Pathology confirmed Meckel's diverticulum with focal ulceration, underlying granulation tissue, and gastric heterotopia. DISCUSSION: Tc-99m pertechnetate scintigraphy (Meckel's Scan) is helpful in diagnosis of a Meckel’s diverticulum as pertechnetate is taken up by mucin-secreting cells of ectopic gastric tissue. This scan has high sensitivity and specificity in children but is drastically lower in adults as hemorrhage due to ectopic gastric mucosa is primarily a pediatric disease. For adults with suspected bleeding from a Meckel's diverticulum with multiple negative imaging modalities including a Meckel's scan, it is important to continue pursuit of the diagnosis using all means available. This case demonstrates the vital importance of provocation angiography in diagnosis of a Meckel's diverticulum that would have otherwise been missed and therefore left untreated.Figure 1.: Negative Meckel’s Scan. No heterotopic gastric mucosa visualized.Figure 2.: Angiogram before tPA administration. Red arrow indicates suspected Meckel diverticulum served by superior mesenteric artery branch.Figure 3.: Angiogram after tPA administration. Red arrow indicates area of extravasation and active bleeding.

Persistent omphalomesenteric duct: a rare cause of acute intestinal volvulus in an adolescent treated by laparoscopy

This report describes the case of a 14-year-old male with a prior history of recurrent abdominal pain and two previous ”sub-occlusive” episodes. He presented at the Emergency Room with abdominal pain, emesis, abdominal distension, painful palpation, and signs of peritoneal irritation. Plain upright abdominal radiography suggested a distal small bowel obstruction. Exploratory laparoscopy showed a tubular structure connecting the antimesenteric border of the terminal ileum and the umbilicus, which was behaving as a rotation axis to the small intestine. The volvulus was laparoscopically de-rotated, and the structure was excised. Histological exam confirmed the diagnosis of persistent omphalomesenteric duct. This case illustrates an intestinal obstruction caused by small intestine volvulus. A high index of suspicion is required to acknowledge this etiology.

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.

Intestinal prolapse through omphalomesenteric fistula, a rare cause of neonatal occlusion: A case report

Abstract Acute intestinal obstruction secondary to omphalomesenteric fistula is a very rare condition. Omphalomesenteric fistula is a consequence of a defect in involution of the vitelline duct between the fifth and ninth week of intrauterine development. We are reporting on a case of neonatal intestinal obstruction due to a prolapse of small bowel through an omphalomesenteric fistula. A newborn baby aged 15 days was admitted in emergency with acute intestinal obstruction lasting for two days. The physical examination found prolapse of small bowel through a persistent omphalomesenteric duct. He received surgical treatment with favorable evolution. The scarcity of the reason during the neonatal period should draw the attention of pediatric surgeons because of its potential complications.

Patent omphalomesenteric duct opening into the vermiform appendix

Introduction: Persistent omphalomesenteric duct anomalies are very rare the world over. these anomalies are in a spectrum and present in various forms, ranging from the infamous Meckel’s diverticulum to a fibrous non-patent connection between the umbilicus and the distal ileum, to a patent connection between the umbilicus and the intestine, the patent omphalomesenteric duct. case report: A twomonth-old female child who was born with a membrane-covered umbilical mass which after sometime, became two swellings with intestinal epithelial covering and fistulous openings. At surgical exploration, she was discovered to have a patent omphalomesenteric duct which opened into the appendix, as well as intestinal malrotation abnormality. conclusion: the occurrence of patent omphalomesenteric duct opening into the vermiform appendix is a rare occurrence and there should be high index of suspicion when there is failure of healing of the umbilical stump and there is discharge of intestinal contents via the umbilicus.

Visual Diagnosis: An 11-Month-Old With Nausea, Vomiting, and an Abdominal Mass

Children with intussusception can present with a wide variety of symptoms, including vomiting, fever,lethargy, and abdominal pain. The classic triad of abdominal pain, hematochezia, and palpable abdominal mass is seen in a few patients.• Early diagnosis of intussusception depends on a high level of clinical suspicion in any child with non specific abdominal findings followed by appropriate radiographic or ultrasonographic evaluation and confirmation with a contrast enema.• Abdominal radiography, although an appropriate component of the initial workup for gastrointestinal symptoms, lacks the sensitivity to reliably exclude the presence of intussusception.• Because ultrasonography is a safe, sensitive, and specific test for the diagnosis of intussusceptions, it should be performed early whenever there is clinical suspicion of intussusception.• Contrast enema is the gold standard for diagnosis and first-line treatment of intussusception. There is an increasing trend for pneumatic reduction of intussusception compared with hydrostatic reduction.Intravenous placement, fluid resuscitation, and notification of the pediatric surgeon should be completed before contrast enema.

Intestinal prolapse through a persistent omphalomesenteric duct causing small-bowel obstruction

Persistent omphalomesenteric duct as a cause of small-bowel obstruction is an exceptional finding. A neonate presented with occlusion due to intestinal prolapse through a persistent omphalomesenteric duct. Remnants of the duct were successfully resected, and the postoperative course was uneventful. We discuss the presentation of omphalomesenteric duct and its management.

Abnormalities of digestive tract innervation in rat fetus treated with ethylenethiourea

The pathophysiology of abnormalities associated with myenteric plexus lesions remains imperfectly understood. Such abnormalities have been correlated with subocclusive intestinal conditions in children with Hirschsprung's disease, cases of chronic constipation and, postoperatively, in cases of anorectal anomalies. This study evaluated abnormalities of the myenteric plexus in fetus from female rats that received ethylenethiourea. Female rats were exposed to ethylenethiourea on the 11(th) day of pregnancy (experimental group) or to 0.9% physiological solution (control group). Abnormalities were only found in the experimental group. The digestive tract muscle layer was analyzed morphometrically and changes to the frequencies of nerve plexus cells and interstitial cells of Cajal were evaluated, using hematoxylin-eosin, S-100 protein, neuron-specific enolase and C-Kit, respectively. Muscle and skeletal abnormalities were observed in 100%, anorectal anomalies in 86%, absent tail in 71%, short tail in 29%, duodenal atresia in 5%, esophageal atresia in 5% and persistent omphalomesenteric duct in 5%. Histopathological analysis showed a thinner muscle layer associated with lower frequencies of ganglion cells and interstitial cells of Cajal, in all gastrointestinal tract. Severe nerve plexus abnormalities associated with muscle layer atrophy were observed throughout the gastrointestinal tract in newborn rats exposed to ethylenethiourea.

A rare cause of small bowel obstruction in adults: persistent omphalomesenteric duct

Previous abdominal surgery is the most common cause of mechanical small bowel obstruction. However, in patients with no abdominal surgery history, it is difficult to diagnose and treat. Omphalomesenteric duct is a primitive embryonic structure of fetal development between the midgut and yolk sac. In some cases, it may persist and result in several complications, particularly in childhood. In adults, intestinal obstruction due to persistent omphalomesenteric duct is an extremely rare circumstance. We report a 42-year-old male patient presenting with omphalomesenteric duct remnant causing small bowel obstruction.

Persistent Omphalomesenteric Duct Causing Small Bowel Obstruction in an Adult

We report an unusual presentation of persistent omphalomesenteric duct causing intestinal obstruction in a middle-aged adult. Exploratory laparotomy revealed persistence of omphalomesenteric duct causing terminal ileum obstruction. Meckel's diverticulum along with gangrenous segment of ileum was resected and end-to-end anastomosis was done.

Symmetrical upper limb peromelia and lower limb amelia associated with persistent omphalomesenteric duct

Symmetrical upper limb peromelia and lower limb amelia associated with persistent omphalomesenteric duct

1149 An Unusual Presentation of Meckel's Band in the Neonatal Period

Background and aims: We report a neonate with a ‘four vessel’ umbilicus, intrauterine volvulus and intestinal perforation secondary to a persistent Omphalomesenteric duct (OMD) / Meckel's band.Case description: A female infant was born at 38 weeks in poor condition requiring extensive resuscitation. She was noted to have a grossly distended, tense, discolored abdomen with distended veins, diaphragmatic splinting and hypovolaemic shock. Four vessels were visualized in the umbilicus, one of which was an unusual brown color and a diagnosis of volvulus secondary to OMD remnant considered.Abdominal x-ray showed a moderately distended, featureless abdomen. Ultrasound scan showed gross ascites of an abnormal dense echogenicity with intestinal debris in keeping with perforation.Laparotomy findings included bowel perforation, Meckel's band with volvulus, and a large meconium cyst. The unviable distal small bowel and ascending colon, which had volved around the OMD band, were excised. A stoma was fashioned proximal to this. She made a good recovery prior to discharge.Conclusions: Our case highlights the clinical significance of a ‘fourth umbilical vessel’ and the risks of OMD bands. Failure to recognise a persistent OMD remnant in the umbilical cord, or to refer the neonate for further investigation, may place the newborn at risk of developing serious complications in early life.

Obstrucción intestinal por remanente onfalomesentérico obliterado en paciente adulto: Reporte de un caso

Bowel obstruction caused by an omphalomesenteric duct remnant. Report of one case Omphalomesenteric duct remnant is one of the least common congenital abnormalities due to vitelline sac persistence. Among the five types of this abnormalities, omphalomesenteric band or obliterated omphalomesenteric duct remnant is the least common. We report a 64 years old male presenting with vomiting, abdominal pain and absence of stools. The patient was operated with the diagnosis of intestinal obstruction and a persistent omphalomesenteric duct that caused the bowel obstruction was found. The patient had an uneventful postoperative period as is discharged 24 hours later.

Persistent omphalomesenteric duct causing small bowel obstruction in an adult

An extremely rare case of persistent omphalomesenteric duct causing small bowel obstruction is presented. A 20-year-old female patient without medical history presented with colicky abdominal pain, vomiting, absence of passage of gas and feces, and abdominal distension of 24 h duration. Physical examination and blood tests were normal. Abdominal X-ray showed small bowel obstruction. Computed tomography of the abdomen demonstrated dilated small bowel and a band originating from the umbilicus and continuing between the small bowel loops; an omphalomesenteric duct remnant was suspected. In exploratory laparotomy, persistent omphalomesenteric duct causing small bowel obstruction was identified and resected. The patient had an uneventful recovery and was discharged on the 5(th) postoperative day. Although persistent omphalomesenteric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history.

An umbilical defect

During their caesarean delivery, one of three triplet fetuses, aged 31 weeks and 2 days, was noted to have a clear shiny sac protruding from the base of the umbilical cord. The defect was immediately covered with moist dressings, which upon removal had some green-yellow staining. Physical examination showed an intact membranous sac containing what seemed to be several loops of bowel. Upon closer inspection of the sac, a small stoma was discovered (figure). 1. What is your diagnosis? 2. What additional diagnostic investigation could be useful in this case? Is it necessary? 3. What is the treatment of choice? 1. There is a protrusion of abdominal contents through a mid-line defect that involves the umbilicus and a surrounding sac. It is the presence of the surrounding sac that classifies this defect as an omphalocele rather than gastroschesis (see discussion). The stoma is the probable source of the fluid drainage and likely represents a patent persistent omphalomesenteric duct. A ruptured omphalocele can be ruled out by the …

Fistule omphalo-mésentérique (à propos d’un cas)

Purpose. – To report a rare case of patent omphalo-mesenteric duct and discuss the pathogenesis, clinical and radiological findings of this pathology. Case report. – A two-month-old infant presented with umbilical liquid production since birth. Local examination showed an inflammatory umbilical tumefaction. Catheterization and injection of contrast material through the canal evidenced a communication with the gut, consistent with a patent omphalo-mesenteric duct. Discussion. – Persistent omphalo-mesenteric duct is a rare affection. Diagnostis is based on clinical and radiological findings. Clinical findings may be atypical in some cases. Complications are severe and include prolapsus, occlusion, ulcus, haemorrhage and perforation. Conclusion. – Diagnostis of patent omphalo-mesenteric duct must be precocious to avoid complications.