Patent vitellointestinal duct with prolapse of inverted loop of small intestine: a case report
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A wide variety of anomalies may occur as a result of the vitellointestinal duct (VID) failing to obliterate completely. Most reports on symptomatic VID focus on Meckel's diverticulum, while other anomalies are given little attention. We report a case of a baby of five months who had an intestinal loop inverted through a patent VID. The inverted loop was reduced and ileostomy was done which was closed after 6 weeks.
KeywordsIntussusception Anterior Abdominal Wall Loop Ileostomy Intestinal Loop Shaped Loop
The midgut enlarges rapidly during the first 5 weeks of gestation and becomes too large for the abdominal cavity; subsequently, it is herniated into the umbilical cord. The apex of the herniated midgut is continuous with the vitellointestinal duct and the yolk sac. The axis of the herniated midgut is formed by the superior mesenteric artery. At approximately the 10th week of gestation, the midgut begins its return into the abdominal cavity. This return occurs by a highly complex developmental process, and as a result, numerous anomalies of the bowel may ensue. These include bowel atresias and stenoses, abnormalities of the vitellointestinal duct, failure of ceacal descent, malrotation, malfixation, reversed bowel rotation and exomphalos.
5 months old male child came with unusual red colored 'Y' shaped loop emerging from the anterior abdominal wall with absent umbilicus. The parents reported that the baby had a small opening in the umbilicus since birth which discharged a sticky greenish material in very small quantity. The child was suffering from cough since 4 days leading to protrusion of the red colored mass from the umbilicus which was small initially but grew over these 4 days till it became carrot sized. Then a branch developed giving it a 'Y' shape.
Failure of obliteration of the embryonic vitellointestinal duct leads to various congenital anomalies like – Meckel's diverticulum, vitelline cord, enteric cyst, umbilical sinus, enteric fistula or hemorrhagic umbilical mass . Patient may present the anomaly itself or due to complications secondary to the anomalies like intestinal obstruction due to volvulus, intussusception or adhesions [2, 3]. Totally patent VID is a very rare anomaly and very few cases were reported in the literature. We found a single case report of ileal prolapse through the patent VID. It was reported in 1985 by Dr. Gvalani AK . Patent vitellointestinal duct may present itself as continuous or intermittent discharge through the umbilicus. The defect which is wide enough or the predisposing conditions which increase intra abdominal pressure leads to partial or total prolapse of the intestine through the patent duct. The condition, if not managed promptly by surgical intervention, may lead to subacute or acute intestinal obstruction, strangulation and gangrene of the prolapsed intestinal loop. Primary closure of the VID following reduction of the prolapse may be possible if the patient arrives early without any gross edema over the intestinal loops. If the defect is large one can go for resection of the loop of intestine near the patent duct followed by primary anastomosis. If the patient arrives late with gross edema or the viability of the intestinal loops is in question then exteriorization of the suspected loop or loop ileostomy is advised.
Patent VID with prolapsed ileal loop is a rare condition needs prompt diagnosis, surgical reduction and repair of the defect.
Mrs. Anupama Nair, Vadodara, India helped in writing the manuscript. Permission for the publishing of the case report is taken from the patients parents.
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