Vitellointestinal Duct Research Articles

HISTOPATHOLOGICAL STUDY OF LESIONS OF UMBILICUS

Background: A variety of lesions either congenital or acquired affect the umbilicus. We present histopathological study of 55 umbilical lesions over a period of 40 months. Material and Methods: Histopathological features of 55 umbilical lesions were analysed. Data of patients was obtained from the hospital records. There were 45 adult and 10 pediatric patients. Results The most common lesion was umbilical hernia constituting 43 cases. We had six cases of vitellointestinal duct remnants (VDR), two cases each of umbilical granuloma and tuberculosis and one case each of patent urachus and epidermal cyst. Conclusion: Although rare, every lesion of the umbilicus needs histopathological examination since certain lesions like umbilical granuloma can be managed conservatively while others like VDR or umbilical hernia need surgical intervention. Also dormant tuberculosis can be diagnosed on histopathological examination of hernial sac.

Liver as sole content of umbilical cord hernia

Hernia of the Umbilical Cord (HUC) is a distinct form of ventral abdominal wall defects, commonly misinterpreted as Omphalocele minor. Usually, the contents are the small intestine, large intestine, or vitello-intestinal duct remnants; but rarely liver, gall bladder, or spleen may entrap into the sac. In this case series, we present three unusual cases of Hernia of the Umbilical Cord with the liver as the sole content. All three underwent surgical intervention and were managed successfully. To the best of our knowledge, there are only a few case reports of such presentations.

A surgical surprise: meckel’s diverticulum complicating as littre’s hernia

Background: Meckel's diverticulum (MD), a true diverticulum with all 3 layers, is the most common congenital anomaly of the gastrointestinal tract is due to the failure of the obliteration of the vitellointestinal duct during the 5th to 9th week of gestation life. MD can present as haemorrhage, obstruction, diverticulitis, intussusceptions or perforation. Here we present a case of strangulated Littre's hernia in the right inguinal region. Case report: A 19-year-old male presented with a right groin swelling of 1-month duration. His swelling was not reducible for the past 1 day. He had associated vomiting of 1-day duration. On examination he was febrile and with a heart rate of 96 per minute. His groin examination revealed a 6 x 4 cm swelling which was tense and tender with absent cough impulse. His Chest X-ray and abdomen were within normal limit. His blood investigation was within normal limits except for a leucocytosis. A provisional diagnosis of strangulated inguinal hernia was made and patient was taken up for surgery. A right inguino-scrotal incision was made. The hernia sac was opened at the fundus. 5ml of toxic fluid was let out. The content was a gangrenous Meckel's Diverticulum which was 8cm in length and about 60 cm from ileocaecal junction. Resection of the gangrenous MD was done with end-to-end anastomosis of the ileum. Postoperative period was uneventful and he was discharged on the 9th post-operative day. Conclusion: Meckel's Diverticulum is one of the rare contents of the hernial sac. Diagnosis is usually intraoperative. Management includes resection of the diverticulum

In-utero segmental volvulus around vitellointestinal duct remnants leading to ileal atresia and stenosis: A case series

Background: The etiology of intestinal atresia is multifactorial with vascular accidents being the most common event in its development. In-utero volvulus is a well-known type of vascular accident leading to intestinal atresia. Segmental volvulus around vitellointestinal duct remnants is rarely described vascular accident leading to ileal atresia. Case Series: We report two cases of segmental ileal volvulus around vitellointestinal duct remnants in neonates leading to ileal atresia in one case and intestinal stenosis in the other one. Both neonates presented with signs of neonatal intestinal obstruction. X-ray abdomen performed in both neonates showed air-fluid levels. Both neonates were operated with suspicion of intestinal atresia. At surgery, a segment of the small bowel was found twisted around vitellointestinal duct remnants in both cases. The first case also had intestinal atresia whereas the second one had intestinal stenosis secondary to the segmental volvulus. Conclusion: Segmental volvulus around vitellointestinal duct remnants can also cause ileal atresia or stenosis.

Hernia of the umbilical cord: a clinical spectrum

Background: Hernia of the umbilical cord is a rare clinical entity which presents with hernia of the small bowel into the proximal part of the umbilical cord. This is sporadically associated with other congenital malformations. This is usually poorly identified and mistakenly termed as ‘omphalocele minor. Inadvertent clamping of the cord in these cases leads to iatrogenic bowel wall injury. The aim of this study is to present a spectrum of cases presenting with umbilical cord hernia in a tertiary care Govt medical college, along with demography, intra operative findings, associated malformations and postoperative outcome and 1 year follow up.Methods: This is an ambispective study on neonates who attended the Outpatient Department (OPD) or Emergency department. The babies were evaluated by age, birth weight, gender, any gross clinical malformation. They were also evaluated intraoperatively for any associated anomalies. Post-surgery the babies were followed up until 2 years of age in pediatric surgery OPD of the same institute and outcome was recorded.Results: Out of 90 babies, 88 babies (97.77%) had body weight more than 2.5 kg, and rest 2(2.22%) had bodyweight of 1.5kg and 1.8 kg. Regarding content of contents of umbilical cord hernia, out of 87 patients, 43 patients (49.42%) had ileal loop as, 32 patients (36.78%) had ileum with Meckel’s diverticulum, 6 patients (6.39%) had cecum with appendix.Conclusions: Most of this study cases had ileal loops as content of the hernial sacs, and 36.78% cases had Meckel’s diverticulum associated, which is a remnant of Vitello intestinal duct. Prompt identification of the condition and early intervention and adequate post-natal care are affective to prevent long term morbidity.

3146 A Curious Case of Hematochezia in a Young Adult

INTRODUCTION: Meckel's diverticulum is a common congenital abnormality of the small intestine secondary to the vitello-intestinal duct. It commonly presents as hematochezia and abdominal pain in young children particularly those less than 2 years old. CASE DESCRIPTION/METHODS: A 26 years old lady presented to Emergency Department with history of hematochezia and abdominal pain for 2 days. The abdominal pain was mainly paraumbilical and colicky in nature and it was present intermittently for the past 6 months. One day prior to this visit, she was treated for acute gastroenteritis by a General Practitioner in view of presence of vomiting and diarrhea. However, symptoms were not improving and she subsequently developed hematochezia. She denies any fever and family history of gastrointestinal disease such as inflammatory bowel disease or malignancy. She denies any recent travelling and there is no sick contact recently. Physical examination was unremarkable and per rectal examination reveals blood mixed with stool with no mass or hemorrhoids seen. She has leukocytosis on blood investigation and abdominal radiograph performed in emergency department was unremarkable. She was subsequently admitted for treatment of dysentery and was started on intravenous ceftriaxone and metronidazole. However, patient's abdominal pain became severe requiring opioid for analgesia and an inpatient Computer Topography scan of her abdomen was obtained. Figures 1 and 2 shows the appearance of bowel within bowel appearance in the right lower quadrant in keeping with ileocolic intussusception. An urgent surgical consult was done and patient was agreeable for operation for bowel resection. Intra-operatively, a Meckel's diverticulum was noted to be the cause of the intussusception. The segment of ileum in the intussusception was noted to be ischemia with gangrene but no perforation noted. The intussuscepted bowel was resected and an end to end ileocolic anastomosis was performed. Post operatively patient recovered well and tolerated orally without any complications. She was discharged subsequently. DISCUSSION: This case illustrated that Meckel's diverticulum could be a differential diagnosis for young adults presenting with hematochezia. It is commonly misdiagnosed preoperatively in view of the rarity of these cases in the adult population.

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.

Meckel's diverticulum and the eponymous legend.

Johann Friedrich Meckel (1781-1833) was a 19th century anatomist born into an eminent dynasty. He was a professor of anatomy, pathology, and zoology at the University of Halle, in Central Germany. The diverticulum, a congenital remnant of the vitellointestinal duct was named after him. Other eponyms include Meckel's cartilage, Meckel syndrome, and Meckel-Serres law of recapitulation. His concepts in comparative anatomy, embryology, and teratology anticipated Darwin. This review is a short tribute to this legend and his prolific contributions. LEVEL: Historic review, level V.

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.

Congenital Umbilical Appendix: A Case Report

Congenital umbilical appendix is rare and has been associated with anomalies of rotation. A case of congenital umbilical appendix with associated fistula and malrotation in a neonate is described with review of relevant literature. Keywords: Appendiculo-umbilical fistula, Umbilical Appendix, Vitello-intestinal duct Cite this Article Avinash Kumar, Pallavi Suman, Sandip Kumar Rahul, et al. Congenital Umbilical Appendix: A Case Report. Research & Reviews: Journal of Surgery. 2018; 7(3): 1–3p.

T-shaped Meckel’s diverticulum: a rare anatomical variant complicating small bowel volvulus

The Meckel's diverticulum is a congenital diverticulum arising from the terminal ileum and is the unobliterated proximal portion of the vitellointestinal duct. Intestinal obstruction due to Meckel’s diverticulum is the most common presentation in adults and is the second most common presentation in children. We present a case of a 58-year-old gentleman presented with acute abdomen who was later found to have Giant T- shaped Meckel’s Diverticulum complicating small bowel volvulus on exploratory laparotomy. A T-shaped Meckel's diverticulum has not yet been described.

Unusual Presentation of Wilms' Tumor as Umbilical Granuloma

AbstractWe report an unusual presentation of a Wilms' tumor in an 8-month-old child, incidentally detected by ultrasonography for an umbilical granuloma. A patent vitellointestinal duct anomaly required surgical excision in the same sitting as the nephroureterectomy. The case is reported for the unusual coexistence and the management implications.

Rare Variant of Meckel’s Diverticulum on the Mesenteric Border Complicated by Perforation: Case Report and Literature Review

Background: Meckle’s Diverticulum (MD) is a remnant of vitello intestinal duct found in approximately 2-4% of normal population and is usually located on the anti-mesenteric border of terminal ileum. Its variant, the mesenteric type is even rarer, with only a few cases reported in literature.Case: We describe a case of inflamed mesenteric MD that presented with clinical findings of acute appendicitis, but, upon exploration, was diagnosed as inflamed mesenteric MD, that was removed, and the patient recovered without any complications and went home in good condition. We also review all the mesenteric MD cases reported in the literature since 1941.Conclusion: MD is a rare operative finding, but knowledge of its rare variant must be kept in mind as the signs and symptoms closely resemble acute appendicitis.

Congenital hernia of the umbilical cord with patent vitello-intestinal duct in a newborn: A rare case

Congenital hernia of the umbilical cord is a less frequent entity in newborns and occasionally associated with other maladies. Sometimes, a large umbilical cord hernia is confused with small omphalocele. We report an unusual case of umbilical cord hernia associated with patent vitello-intestinal duct in a male newborn who underwent surgery and discharged with good general condition.

Rare presentation of patent vitellointestinal duct-meckel's diverticulum and vitelline cyst-A case report

Meckel's diverticulum is one of the most common anomalies of the gastrointestinal tract. Many of them remain unexpressed and are discovered accidentally. Vitello-intestinal duct anomalies are rare and occur in 1–2% of the population. These anomalies may present in adult life like appendicitis; hence, proper investigations will reveal the correct diagnosis. Meckel's diverticulum requires surgical correction. Here, we present a rare case report of Meckel's diverticulum with Vitelline cyst in a 21-year-old male patient, which was successfully resected surgically.

Urachal remnants presenting as an umbilical sinus in middle age: a rare case report

Urachal sinus is a rare type of Vitello intestinal duct anomalies. Clinical presentation is that of persistent umbilical discharge. It is usually seen in paediatric age group. Moreover, they have a different course in adults than 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. Early removal of urachal remnants at first diagnosis is key for preventing future morbidities. In our case, all the three remnants (Vitello intestinal duct, urachus and ligamentum venosum) were found in a middle-aged patient and hence is unusual and a rare presentation.

Umbilical Cord Hernia: Report of an Unusual Case

Congenital umbilical cord hernia is fairly common in infants and it is rarely associated with other anomalies. Sometimes, large umbilical cord hernia is confused with Small omphaloceles. We report an unusual case of umbilical cord hernia associated with patent vitello-intestinal duct (PVID), and Meckel's diverticulum underwent surgery and discharged with good general condition.

New-born born with patent vitellointestinal duct with prolapsed (intussusceptions) of proximal and distal ileal loop: A case presentation

Abstract Failure of obliteration of vitellointestinal duct (VID) can present with a wide variety of congenital intestinal malformations. Patient can present with the anomaly itself or due to complications secondary to the anomaly like intestinal obstruction due to volvulus, intussusception or adhesions. Prolapsed ilial loops through a patent VID is a rare presentation of the above. To date only fourteen cases of this presentation have been reported in the English medical literature. We are reporting a case of the same in a new-born presenting with it from the time of birth, which to the best of our knowledge has not been reported before and therefore this the youngest reported case of its nature in the current English medical literature.