Vitellointestinal Duct Research Articles

Patent vitello-intestinal duct with a rare presentation of reverse intussusception with appendicular agenesis: A case report

Background: Vitello-intestinal duct (VID) is found in approximately 2% of newborns, with patency in about 6%. Failure of obliteration leads to some anomalies, most commonly Meckel’s diverticulum. Protrusion of the small bowel is one of the rare presentations. Case Presentation: A 10-month-old male infant presented with a prolapsed, irreducible polypoid-shaped loop of intestine protruding from the anterior abdomen. On exploratory laparotomy, patent VID was confirmed with appendicular agenesis and reverse intussusception. Gangrenous bowel was resected, followed by end-to-end ileo-ileal anastomosis, with a favorable outcome. Conclusion: Patent VID with ileal intussusception and prolapse is a rare entity, which can be easily diagnosed clinically. A high index of suspicion is needed for any associated gut anomaly in these cases, like appendicular agenesis.

Patent Urachus with Patent Vitellointestinal Duct: A Rare Simultaneous Occurrence.

A large number of congenital anomalies often involve the umbilicus. This is a report of two such anomalies together in an infant. The child had a mass protruding from the umbilicus since birth. The urachus was noted to be patent on voiding cystourethrogram. On exploration, a patent vitellointestinal duct was also noted. Resection and anastomosis was done for the vitellointestinal duct, and the urachus was excised close to the dome of the bladder. Histopathological examination confirmed a tube lined by intestinal epithelium and the urachal remnant showing a dense fibrous tube-like structure. The omphalo-mesenteric vessels are located between the urachus and the patent vitellointestinal duct, and care should be taken while incising or dissecting in this region to prevent bleeding.

Patent vitellointestinal duct treated during infancy: Case series with literature review

Patent vitellointestinal duct treated during infancy: Case series with literature review

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.

Meckel’s diverticulum with varied clinicopathological presentations: A case series at a rural tertiary care center

Meckel’s diverticulum (MD), first documented by Wilhelm Fabricius Hildanus in 1598 as a small bowel diverticulum and later detailed by Johann Friedrich Meckel in 1809, is a remnant of the vitellointestinal duct connecting the fetal gut with the yolk sac. It is a true diverticulum, comprising of all the layers of the bowel wall. The commonly cited “rule of 2s” regarding the diverticulum is: Occurs in 2% of the population, has a 2:1 male-to-female ratio, usually discovered by 2 years of age, located 2 feet from the ileocecal valve, and commonly 2 cm in diameter and 2 inches long. Most Meckel diverticula are benign and are incidentally discovered during autopsy, laparotomy, or barium studies. Vitellointestinal duct lining cell being pluripotent, heterotopic tissues such as gastric, pancreatic followed by others might be found. Common clinical presentation in symptomatic cases is gastrointestinal hemorrhages followed by intestinal obstruction, diverticulitis, cystic abdominal mass, patent umbilical fistula, and neoplasm. Clinical signs and symptoms are non-specific simulating other abdominal emergencies and routine radiology is unable to detect the anomaly in rural peripheral centers. Hence, prompt surgical intervention may be needed in emergency cases. Diverticulectomy or ileal segment resection with end-to-end anastomosis is done. Due to the difficulty of diagnosing a pathologic MD pre-operatively, many surgeons recommend prophylactic diverticulectomy in those found incidentally.

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.

Demographics, Clinical Presentation, and Surgical Procedures Performed for the Persistent Vitellointestinal Duct During Infancy: A Systematic Literature Review of the Past Fifty Years from 1971 to 2021

ABSTRACT The persistent vitellointestinal duct is the rarest of all vitelline duct anomalies. This systematic literature review was undertaken to investigate and review the demographics, clinical presentation, surgical procedure performed, and outcome of infants who were operated upon for the persistent vitellointestinal duct. Infants with incomplete desired details, and children/cases operated upon for the above-mentioned anomaly after infancy were excluded. Published literature/manuscripts were retrieved for the previous fifty years from 1971 to December 2021, and the manuscripts were retrieved through an online database search. This review is presented in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A total of n = 280 infants who were operated upon for the patent vitelline duct were recruited for the systematic review. More than three-fourths (n = 217, 77.5%) of infants were boys. Ninety percent of infants were under the age of 3 months, and 72% were neonates/newborn babies. Discharges through the umbilicus (n = 148; 52.85%), and prolapse of the bowel through the umbilicus (n = 117; 41.78%) were the chief complaints in the above-mentioned infants. Operative procedures were performed (n = 280) in the following order of frequency: (1) resection of the persistent vitellointestinal duct, small adjacent segment of ileum, and ileo-ileal anastomosis (n = 121, 43.21%); (2) resection of the persistent vitellointestinal duct, wedge resection of ileum, and ileal repair (n = 88; 31.42%); and (3) other surgical procedures (n = 11, 3.92%). Operative details were not clear/not available/not provided for n = 60 (21.42%) of the infants. Peri-umbilical incisions were more frequently employed for surgical therapy. This review revealed postoperative death in n = 17 (6.07%) infants. The persistent vitellointestinal duct must be surgically resected at the earliest, preferably during the neonatal period.

A Rare Case of Perforated Meckel’s Diverticulum Coexisting with Acute Appendicitis

Meckel’s Diverticulum is a common congenital anomaly of the gastrointestinal tract due to persistence of vitellointestinal duct. It is usually found as an incidental finding in approximately 2 to 4 % of population in patients undergoing appendicectomy or any other gastrointestinal pathology. Obstruction, gastrointestinal bleeding, diverticulitis and perforation are the various presentations of complicated Meckel’s diverticulum. Incidence of perforated Meckel’s diverticulum is only about 0.5%. Coexistence of appendicitis with perforated Meckel’s diverticulum is a rare presentation thus, making routine search for meckel’s diverticulum intraoperatively in all cases of appendicitis a mandatory practice. Here we report such a rare case of coexistence of perforated meckel’s diverticulum with acute appendicitis in a 12 year female patient.

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

A CASE REPORT: INTESTINAL OBSTRUCTION DUE TO MECKLE'S DIVERTICULUM

Meckle's Diverticulum is a congenital anomaly resulting from incomplete obliteration of the omphalomesenteric duct/ vitello-intestinal duct. People who have Meckle's Diverticulum go through life without facing any symptoms and Meckle's Diverticulum being only an incidental nding. But in some cases, complications involving a Meckle's Diverticulum may mimic other diseases and obscure the process of early diagnosis, especially in cases on Meckle's Diverticulum causing Small Bowel Obstruction

Meckel’s diverticulitis with abscess presentation in an acute abdomen

The vitellointestinal/omphalomesenteric duct is embryonic structure connecting primary yolk sac to the embryonic midgut which obliterates by 10th week of gestation. It may persist or incompletely obliterate to form anomalies like Meckel’s diverticulum that is most common and is usually asymptomatic. Symptoms develop when Meckel’s diverticulum involves complications such as hemorrhage, inflammation, and perforation, or when it causes intussusception or bowel obstruction. The modalities useful in diagnosing it are ultrasonography (USG) and computed tomography (CT), USG being more easily available, and radiation free is the first modality useful to suspect these anomalies. It can mimic close differentials such as appendicitis and urachal anomalies. In this case report, a 12-year-old male child presented with recurrent periumbilical pain who was screened on USG was suspected Meckel’s diverticulitis with abscess; the same was confirmed on contrast CT scan and managed surgically. This case shows the importance of USG and radiologist’s suspicion of Vitellointestinal duct anomalies in diagnosing and its associated complications.

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.

A Systematic Literature Review of Demographics, Clinical Presentation and Surgical Procedures Performed for the Appendico-Umbilical Fistula for the Past 100 Years

Abstract The persistent vitellointestinal duct (PVID) is the rarest of all the vitelline duct anomalies. The enteric end of the vitelline duct mostly connects to the terminal ileum. The appendico-umbilical fistula (appendiceal-umbilical fistula) in which the proximal end of the vitelline duct connects to the appendix is a rare clinical entity. This systematic literature review was carried out to review the demographics, clinical characteristics and operative procedures executed for the appendico-umbilical fistula. Literature/cases with incomplete desired details for the above-mentioned anomaly were excluded. The guidelines of the preferred reporting items for systematic reviews and meta-analyses are followed for presenting this manuscript. An online search was made for the retrieval of the published manuscripts. The search was performed for the previous 100 years from 1921 to December 2021. A total of n = 21 (n = 12 female and n = 9 males) cases of the appendico-umbilical fistula were included in the systematic review. All the cases, except one, were infants and n = 10 of the cases were neonates/newborn babies. Their ages ranged from 1 day to 5 years. Three-fourths (n = 16) of the children presented with the chief complaint of discharge of mucus/stool through the umbilicus. An appendicectomy with resection of the PVID/fistulous duct/prolapsed mucosa was executed as the standard operative procedure for the entire case. A peri-umbilical incision was preferred and frequently employed for surgical therapy. This review revealed only one (4.76%) post-operative death that was unrelated to the surgical procedure. PVID connected to the appendix, presented clinically as appendico-umbilical fistula is a rare entity. The standard surgical procedure performed for the appendico-umbilical fistula was an appendicectomy with resection of the PVID/fistulous duct/prolapsed mucosa.

AN INTERESTING CASE OF MECKELS DIVERTICULUM CAUSING INTESTINAL OBSTRUCTION

Meckels diverticulum is a persistent remnant of the vitellointestinal duct, and is one the most commonly diagnosed congenital surgical conditions. It occurs in 2% of the population, is usually two inches long, two feet proximal from the ileocaecal junction and in approximately 20% cases it is seen to contain heterotropic epithelium. Its most common clinical presentations are usually in the form of haemorrhage, diverticulitis and rarely may complicate causing intestinal obstruction. We hereby present one such case of intestinal obstruction in a young adult male, secondary to small bowel volvulus around a vitellointestinal band extending from a meckels diverticulum to the anterior abdominal wall. The presentation and management of this case, which had presented to the Emergency Department of our hospital, is elaborated in detail.

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.

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

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

Prolapsed vitello-intestinal duct and ileal limbs in a newborn

Vitello-intestinal ducts anomalies has been described extensively in literatures, however - a prolapsed vitello-intestinal duct with prolapsed ileum is extremely rare and might be challenging diagnostically. We describe a baby boy who was born with a reddish mass arising from the abdominal wall. He had early surgical correction, and the diagnosis was confirmed intra operatively. The vitello-intestinal duct was resected as well as some part of the edematous ileum, and ileal anastomosis was performed. He had uneventful recovery.