Vitellointestinal Duct Research Articles

Comparison between removal of umbilicus versus saving the umbilicus along with umbilical sinusectomy for infected umbilical sinus

Umbilical sinus is a very rare variety of malformation among all the vitellointestinal duct anomalies. There are two causes of umbilical sinus. One arising from the remnants of vitellointestinal duct and another arising from the remnants of allantois (urachal sinus). Its clinical presentation is that of persisting umbilical discharge in younger children and young adults. Surgical intervention is the recommended treatment for most of these anomalies. A study was done on 50 patients who were diagnosed as umbilical sinus. 25 patients were subjected to sinusectomy with umbilicus excision and another 25 patients were subjected to sinusectomy with saving the umbilicus. Wound infections was noted in 8 of the patients whose umbilicus was saved. Later on they had recurrence of discharge from the umbilical sinus which required resurgery along with removal of umbilicus. In the other group whose umbilicus was removed only one had post operative wound infection which healed well without leading to persistence of discharge and required no further surgery. This study we tried to conclude that removing the umbilicus along with the sinusectomy is better choice of procedure than leaving behind the umbilicus.

Remenant of vitellointestinal duct with vitelline cyst causing volvulus of small bowel

We report a case of 14 year old male who presented with abdominal pain for 1 day. Our initial clinical suspicion was complicated acute appendicitis, which was later supported by ultrasonogram. His CT abdomen revealed acute intestinal obstruction. Subsequently he was taken up for emergency laparotomy which revealed a fibrous cord like remnant of vitellointestinal duct with a Vitelline cyst causing volvulus of small bowel. The cord along with cyst was excised. The gangrenous bowel was resected and an ostomy was fashioned. Post operative period uneventful and evaluation for any associated congenital malformations revealed none.

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.

Torsion of giant Meckel’s diverticulum causing acute small bowel obstruction

Meckel’s diverticulum occurs in 2% of the population and is the most common congenital anomaly of the small intestine. It is the only true diverticulum of the small intestine and occurs due to the persistence of a part of the vitello intestinal duct that does not undergo normal obliteration by the fifth to ninth week of gestation. Though the majority are clinically silent, there is a 4-6% lifetime risk of complications. Axial torsion is the rarest complication associated with Meckel’s diverticulum and its coexistence with intestinal obstruction is largely unheard of with reported cases being few and far between. Here we discuss one such case of axial torsion of a giant Meckel’s diverticulum associated with intestinal obstruction in an adult male.

A Case Report of Adult Patent Vitellointestinal Duct Sac and Midgut Volvulus

Midgut volvulus is a clinical rare condition which appears as recurrent intermittent abdominal pain after consumption of food with intermittent colicky pain and sometimes with completely asymptomatic period. This gut twist may result in complications such as ischemia, obstruction, hemorrhage, or perforation. In the yolk sac during the third week of intrauterine life, there is normal communication with intraembryonic gut. During development proceeds, this communication gets thinner into a tube known as the vitellointestinal duct. Vitellointestinal duct usually becomes obliterated before eighth week of intrauterine life. In about 2% of people this duct persists and gives rise to a group of anomalies such as Meckel’s diverticulum is the commonest and complete patency of the duct is the rarest. Here we present the case of a 34-year-old male who presented with both conditions.

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.

HISTOMORPHOLOGICAL FINDINGS AND CLINICO-RADIOLOGICAL CORRELATION OF INTESTINAL ATRESIA AT A TERTIARY CARE CENTRE

Background: An atresia is a congenital defect of a hollow viscus that results in complete obstruction of the lumen. Intestinal atresia is one of the most frequent causes of bowel obstruction in the newborn and can occur at any point in the gastrointestinal tract. This study was undertaken to study the histomorphological findings of intestinal atresia and to correlate it with different subtypes and clinico-radiological feature. Material and methods: This was a prospective observational study conducted in 24 months on the resected gastrointestinal tract of 40 neonatal intestinal obstruction cases admitted in Pediatric surgery ward received in the Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna. Control Group- A total of 5 cases of vitello-intestinal duct patency were taken as control and compared with the study group. Results: With respect to total 40 cases, there were six, i.e. 15.0% female babies and 34, i.e. 85.0% male babies studied. Out of that, 15 i.e. 37.50% were full term and 25, i.e. 62.5% were premature. Mucosa showed oedema, ulceration and flattening in 9 cases. Apart from flattening and oedema, mucosa was denuded at some places and also showed congestion and extravasated blood in 6 cases each. Abnormal villus configuration, calcium deposition in 4 cases each and hypertrophied mucosa were found in 3 cases. Luminal narrowing, loss of mucosa, duplication of mucosa and gangrenewere found in one case each. Sub mucosal changes showed congestion in 33 cases, oedema in 15, Fibrosis in 4, thickened submucosa in 2 cases and dilated irregular branching blood vessels, extravasted blood, calcification in 1 case each. Muscularispropria having changes i.e. thinning in 16 cases, congestion, hypertrophy in 4 cases each, focal loss in 3 cases, calcification in 2 cases and thinning in 2 cases. Similarly, histopathological changes in serosa shows serositis in 16 cases, congestion in 11 cases and thinning in 3 cases. Oedema and congestion were present in 2 cases, hypertrophy and calcification in 1 case each. Conclusion:In this study spectrum of histomorphological changes in the atretic segment has been described. Histomorphological changes at atretic segment can be valuable to surgeons in deciding the type of surgery and minimizing the postoperative intestinal dysmotility, which remains the most common complication of intestinal atresia.

Meckel’s diverticulum and its plethoric presentation in paediatric surgery: a case series

Meckel’s diverticulum (MD) is a congenital abnormality of the gastrointestinal tract resulting from incomplete obliteration of the vitellointestinal duct by 5th to 7th week of gestation. Incidence is 2% in the general population with a 2:1 male to female ratio. The various presentations of MD include gastrointestinal bleeding, intestinal obstruction, diverticulitis and intestinal perforation. Majority of the MD is asymptomatic however the potential risk of developing complication it's about 4-6%. Preoperative diagnosis of MD is challenging. We present 6 cases of MD managed at our centre over the course of 1 year. Two cases presented as intestinal obstruction secondary to mesodiverticular band from MD, one case with bleeding, two cases with intussusception and one case of meckel’s diverticulitis.

\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.

Effectiveness of table salt versus copper sulphate in treating umbilical granuloma: A pilot randomized controlled trial

BackgroundUmbilical granuloma is a common infantile condition which usually responds to non operative management. Copper sulphate (CuSO4) is often used as chemical cauterization but can cause superficial skin burns. An alternative is table salt (NaCl), which osmotically dehydrates wet granulation tissue causing necrosis. We aimed to compare the effectiveness of NaCl versus CuSO4 in treating umbilical granuloma. MethodWe performed a multi centerrandomized controlled trial involving three regional pediatricsurgical units. We included children who presented with umbilical granuloma from December 2018 to May 2020. Children who received treatment prior to index visit were excluded. They were randomly allocated to receive NaCl (twice/day application for 5 days by caregiver) or CuSO4 (single application by clinician). Demographic data, compliance in the NaCl group by pill counting method, treatment outcomes, and complications were recorded. Treatment success was defined as complete lesion resolution. Partial or no response was considered treatment failure. Subsequent treatment then reverted to the respective center’s routine management. ResultWe recruited 70 participants with 6 dropouts (2 defaulters, 1 vitellointestinal duct, 3 urachal remnants), leaving 64 subjects for final analysis: 31 NaCl, 33 CuSO4. Compliance rate of 77.4% was recorded for NaCl, with 6 (20%) ‘poor compliance’ participants stopping therapy before completion owing to complete resolution. NaCl group had a significantly higher complete resolution rate (90.4%) compared to CuSO4 (69.7%), p = 0.040. No NaCl participant developed complications versus 9% (n = 3) in CuSO4 (periumbilical superficial skin burn). ConclusionTable salt is an ideal treatment choice for umbilical granuloma as it is effective, safe, and readily available. Level of evidenceII.

Clinicopathological profile of paediatric vitellointestinal duct anomalies

Background: Vitellointestinal duct (VID) or Omphalomesenteric duct (OMD) is the embryonic connection between the yolk sac and the primitive midgut. Anomalies result from failure of the involution of the VID. Normally, it obliterates between the fifth and seventh weeks of fetal life. They include Meckel’s diverticulum (MD), fibrous band, fistula, sinus tract, cyst, and umbilical polyp. Symptomatic cases require surgical correction. They are characterised by different clinical presentations and histological appearances. This study gathers a single paediatric institutional experience of VID remnants, their demographic, clinical profile, varied histomorphology including the presence of ectopic tissues. Aims and Objectives: The objective of this study was to retrospectively review all the symptomatic cases of VID abnormalities at a tertiary pediatric referral hospital. The demographic profile, clinical presentation, and histopathology were reviewed and descriptively analyzed. We classified these anomalies based on embryology and histology. The findings of this study will provide insights to pathologists and treating clinicians less exposed to these rare lesions. Materials and Methods: Data was retrieved retrospectively from the pathology records of a tertiary paediatric referral institute for 3 years. Histological slides of VID anomalies were reviewed and a descriptive analysis of the findings was performed. A thorough review of the literature was also done on these very rare lesions and their findings compared to our results. Results: A total of 60 cases of VID anomalies were encountered during the study period. There was significant male preponderance. The most common age group at surgery was infancy. MD was the commonest VID anomaly. The least common was vitelline fistula and only a single case was encountered in the study period. Ectopic tissues were seen in 25% of the cases and included gastric and colonic mucosae and pancreatic tissue. Conclusion: The histopathology of VID anomalies provides an interesting diagnostic experience for the reporting pathologist. Awareness of the embryology, presentation and histology of these lesions aids in accurate diagnosis.

Exomphalos with intestinal fistulation: Case series and systematic review for clinical characterization, management and embryopathogenesis

IntroductionExomphalos with intestinal fistulation (EIF) is a rare variant of exomphalos with intestine opening to the surface of an intact sac, and may result in a diagnostic challenge. We report 3 new cases and conducted a systematic review of the literature, to characterize its association with the type of exomphalos and vitellointestinal duct (VI) as well as to evaluate its management and outcomes. MethodsA literature search from PubMed using keywords pertaining to exomphalos and fistulation was used to identify all unique cases reported between 1950 and 2020, in addition to the case series reported here, to establish the clinical presentation, histological findings, management and outcomes. ResultsWe found a total of 28 cases of EIF, of which 25 had been reported in 70 years from 19 reports. There was a male predominance (4-to-1 ratio). The majority presented as an exomphalos minor (n = 23, 82%) with a prolapsing patent VI duct (n = 16, 57%), most had evidence of Meckel's diverticulum (n = 25, 89%). All but one case were managed by fistula excision with or without ileal resection and anastomosis, followed by primary closure of the abdominal wall defect. All patients, except one with Trisomy 13 who received only palliative care, underwent surgery. Post-operative complications occurred in 7 patients (25%). Congenital anomalies were present in 12 (43%) and none had Beckwith-Wiedemann syndrome. Mortality occurred in 4 patients (14%) between 3 and 17 days. One EIF with exomphalos major failed early conservative treatment due to sac disintegration and sepsis, requiring staged closure, but had a good outcome. DiscussionEIF is a rare entity usually associated with exomphalos minor and vitelline duct involvement. EIF presentation is variable but primary surgery is the mainstay of treatment with generally good outcomes. Common features of EIF suggest a different embryopathogenesis to other forms of exomphalos.

Concurrent intestinal malrotation and Meckel's diverticulum presenting as acute intestinal obstruction in an adult

Intestinal malrotation is the partial or complete failure of rotation of midgut around the superior mesenteric artery, while Meckel’s diverticulum is the remnant of vitellointestinal duct and concurrence of these congenital abnormalities in an adult is considered a rarity. Till date only 3 cases of concurrent intestinal malrotation and Meckel's diverticulum have been reported. We report a 18 years male who presented with a 3 day history of abdominal pain, bilious vomiting, obstipation and chronic abdominal pain on and off since 3 years of age. During the last episode which occurred 1 year back, he was diagnosed with intestinal malrotation with subacute intestinal obstruction and was treated conservatively. Examination revealed the presence of signs of peritonitis. After resuscitation, CECT abdomen was taken which showed dilated small bowel loops in the subhepatic region associated with malrotation. Emergency laparotomy revealed a Ladd's band below which the gangrenous small bowel loops 150 cm from the duodenojejunal (flexure until 5 cm proximal to the ileocecal junction) were found herniating into the subhepatic region with a Meckel’s diverticulum and a right sided DJ flexure. We proceeded with the band release and resection of gangrenous bowel followed by proximal jejunostomy with distal ileostomy. HPE was consistent with Meckel’s diverticulitis without any ectopic gastric or pancreatic mucosa. Ostomy reversal was done after 8 weeks. Patient had an uneventful postoperative recovery during both the admissions and he is on regular follow-up now.

Patent Vitello - Intestinal Duct: A Case Report


 
 
 
 A wide variety of anomalies may occur as a result of the vitello- intestinal duct (VID) failing to obliterate completely. These anomalies occur in approximately 2% of the population and may remain silent throughout life or may present incidentally with an intra-abdominal complication. Complete patency of vitello-intestinal duct is the rarest of all the anomalies of VID. We report a case of 27 day old female presenting with pinkish umbilical mass since birth referred to us by a paediatrician as umbilical granuloma, which turned out to be patent vitello- intestinal duct.
 
 
 

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

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.

Tuberculous Perforation of Meckel’s Diverticulum

Meckel’s Diverticulum (MD) is an example of a true diverticulum, consisting of all the three layers of small intestine. It is a remnant of omphalomesenteric (vitellointestinal) duct found on the antimesenteric side of the ileum. Perforation of MD is an uncommon complication of an effectively uncommon abnormality, which regularly mimics an appendicular perforation clinically. Although intestinal tuberculosis is a major issue in many parts of the world, a handful of cases of tubercular perforation of MD have been reported in the literature till date. This case of tubercular perforation of MD was reported due to the rarity of the condition and presence of fairly less literature on the topic. A 30-year-old male patient presented with abdominal pain, fever, vomiting. On examination, tachycardia, guarding, rigidity and rebound tenderness were observed. Exploratory laparotomy revealed perforation of MD with inflammation of ileum and caecum with dense adhesions. Proximal loop ileostomy was made. Histopathology showed features of tuberculosis. Postoperative recovery was uneventful and patient was started on antitubercular treatment and 4 kgs weight gain on follow-up after one month.

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.