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Omphalomesenteric Duct and Urachal Remnants

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Rickham's Neonatal Surgery

Abstract

The umbilical cord remnant usually separates in the neonatal period and its persistence beyond the first couple of months is considered abnormal.

Umbilical abnormalities may present with failure of the umbilical cord to separate, omphalitis, mass lesions, or discharge. The commonest umbilical lesion in the neonate is an umbilical granuloma. Other abnormalities are umbilical polyps, omphalomesenteric duct and urachal remnants. It is essential to distinguish between these conditions in order to initiate appropriate treatment.

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References

  1. Ente G, Penzer PH. The umbilical cord: normal parameters. J R Soc Health. 1991;111(4):138–40.

    Article  CAS  PubMed  Google Scholar 

  2. Snyder CL. Current management of umbilical abnormalities and related anomalies. Semin Pediatr Surg. 2007;16:41–9.

    Article  PubMed  Google Scholar 

  3. Pollak R. Adjunctive procedure in intestinal surgery. In: Fischer JE, editor. Mastery of surgery. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 1392–3.

    Google Scholar 

  4. Sharma R, Jain V. Emergency surgery for Meckel’s diverticulum. World J Emerg Surg. 2008;3:27.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Morgagni GB. The seats and causes of disease investigated by anatomy (Translated from the Latin by Benjamin Alexander). London: A Millar and T Cadell; 1769. p. 141.

    Google Scholar 

  6. Amos C. Meckel’s diverticulum: a pathological study of 63 cases. Am J Dis Child. 1931;42:544–53.

    Article  Google Scholar 

  7. Hadley MN, Cogswell HD. Unusual origin of a Meckel’s diverticulum from the base of the appendix. JAMA. 1936;106:537–8.

    Article  Google Scholar 

  8. Meckel JF. Uber die divertikel am darmkanal. Arch Physiol. 1809;9:421–53.

    Google Scholar 

  9. Gokhan Y, Sadettin C, Turgut T. Perforation of Meckel’s diverticulumby a chicken bone, a rare complication: report of a case. Surg Today. 2004;34:606–8.

    Google Scholar 

  10. Uppal K, Tubbs RS, Matusz P, Shaffer K, Loukas M. Meckel’s diverticulum: a review. Clin Anat. 2011;24:416–22.

    Article  PubMed  Google Scholar 

  11. Ruscher KA, Fisher JN, Hughes CD, Neff S, Lerer TJ, Hight DW, Bourque MD, Campbell BT. National trends in the surgical management of Meckel’s diverticulum. J Pediatr Surg. 2011;46:893–896.

    Article  PubMed  Google Scholar 

  12. Schoenwolf GC, Bleyl SB, Brauer PR, Francis-West PH. 2009. Larsen’s human embryology. 4th edn. Philadelphia: Churchill Livingstone. p. 15, 106, 128–162.

    Chapter  Google Scholar 

  13. Malik AA, Shams-ul-Bari WKA, Khaja AR. Meckel’s diverticulum- revisited. Saudi J Gastroenterol. 2010;16:3–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Manning VR, McLaughlin EF. Persistent omphalomesenteric (vitelline) artery causing intestinal obstruction and gangrene of Meckel’s diverticulum. Ann Surg. 1947;126:358–65.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Haubrich WS, Schaffner F, Berk JE, editors. Gastroenterology. Philadelphia: Saunders; 1995. p. 12–4.

    Google Scholar 

  16. Giusti S, Iacconi C, Giusti P, Minuto M, Caramella D, Bartolozzi C. Ileal invaginated Meckel’s diverticulum: imaging diagnosis (2004:9b). Eur Radiol. 2004;14:2368–71.

    Article  PubMed  Google Scholar 

  17. Artigas V, Calabuig R, Badia F, Ruis X, Allende L, Jover J. Meckel’s diverticulum: value of ectopic tissue. Am J Surg. 1986;151:631–4.

    Article  CAS  PubMed  Google Scholar 

  18. Turgeon DK, Barnett JL. Meckel’s diverticulum. Am J Gastroenterol. 1990;85:777–81.

    CAS  PubMed  Google Scholar 

  19. Madhyastha S, Prabhu VL, Saralaya V, Prakash. Meckel’s diverticulum: A case report. Int J Morphol. 2007;25:519–22.

    Article  Google Scholar 

  20. Horgan EJ. Accessory pancreatic tissue. Arch Surg. 1921;2:521–34.

    Article  Google Scholar 

  21. Ogata H, Takehito O, Hiroki I, Shuichi T, Minoru Y. Heterotopic pancreas in children: review of the literature and report of 12 cases. Pediatr Surg Int. 2008;24:271–5.

    Article  PubMed  Google Scholar 

  22. Williams RS. Management of Meckel’s diverticulum. Br J Surg. 1981;68:477–80.

    Article  CAS  PubMed  Google Scholar 

  23. Garretson DC, Frederich ME. Meckel’s diverticulum. Am Fam Physician. 1990;42:115–9.

    CAS  PubMed  Google Scholar 

  24. DiGiacomo JC, Cottone FJ. Surgical treatment of Meckel’s diverticulum. South Med J. 1993;86:671–5.

    Article  CAS  PubMed  Google Scholar 

  25. Martin JP, Pamela DC, Kerri C. Meckel’s diverticulum. Am Fam Physician. 2000;61:1037–42.

    CAS  PubMed  Google Scholar 

  26. Limas C, Konstantinos S, Anagnostoulis S. Axial torsion and gangrene of a giant Meckel’s diverticulum. J Gastrointest Liver Dis. 2006;15:67–8.

    Google Scholar 

  27. Segal SD, Albrecht DS, Belland KM, Elster EA. Rare mesenteric location of Meckel’s diverticulum, a forgotten entity: a case study aboard USS Kitty Hawk. Am Surg. 2004;70:985–8.

    PubMed  Google Scholar 

  28. Jay GD III, Margulis RR, McGraw AB, Northrip RR. Meckel’s diverticulum; a survey of one hundred and three cases. Arch Surg. 1950;61:158–69.

    Article  PubMed  Google Scholar 

  29. Hollinshead WH. The jejunum, ileum and colon. In: Hollinshead WH, editor. Anatomy for surgeons, vol. 2. New York: Harper & Row; 1971. p. 478–86.

    Google Scholar 

  30. Manukyan MN, Kebudi A, Midi A. Mesenteric Meckel’s diverticulum: A case report. Acta Chir Belg. 2009;109:510–2.

    Article  CAS  PubMed  Google Scholar 

  31. De Boer NK, Kuyvenhoven JP. Rectal Meckel’s diverticulum. Endoscopy. 2009;41:E258.

    Article  PubMed  Google Scholar 

  32. Moore GP, Burkle FM. Isolated axial volvulus of a Meckel’s diverticulum. Am J Emerg Med. 1988;6:137–42.

    Article  CAS  PubMed  Google Scholar 

  33. Menezes M, Tareen F, Saeed A, Khan N, Puri P. Symptomatic Meckel’s diverticulum in children: a 16-year review. Pediatr Surg Int. 2008;24:575–7.

    Article  PubMed  Google Scholar 

  34. Hajivassiliou CA. Intestinal obstruction in neonatal/pediatric surgery. Semin Pediatr Surg. 2003;12(4):241–53.

    Article  CAS  PubMed  Google Scholar 

  35. Moore TC. Omphalomesenteric duct malformations. Semin Pediatr Surg. 1996;5:116–23.

    CAS  PubMed  Google Scholar 

  36. Perlman JA, Hoover HC, Safer PK. Femoral hernia with strangulated Meckel’s diverticulum (Littre’s hernia). Am J Surg. 1980;139:286–9.

    Article  CAS  PubMed  Google Scholar 

  37. Brunicardi FC. 2005. Schwartz’s Principles of Surgery. 8th Ed. New York: McGraw-Hill. p 1043–1044. Stewart IC. 1985. Neurovascular hamartoma in a Meckel’s diverticulum. Br J Clin Pract 39:411–412.

    Google Scholar 

  38. Malhotra S, Roth DA, Gouge TH, Hofstetter SR, Sidhu G, Newman E. Gangrene of Meckel’s diverticulum secondary to axial torsion: a rare complication. Am J Gastroenterol. 1998;93:1373–5.

    Article  CAS  PubMed  Google Scholar 

  39. Sy ED, Shan YS, Yang YR, et al. Hirschsprung’s disease, a rare precipitating factor in neonatal perforated Meckel’s diverticulum. J Pediatr Surg. 2006;41:1319–21.

    Article  CAS  PubMed  Google Scholar 

  40. Mishalany HG, Pereyra R, Longerbeam JK. Littres hernia in infancy presenting as undescended testis. J Pediatr Surg. 1982;17(1):67–9.

    Article  CAS  PubMed  Google Scholar 

  41. Lee KH, Yeung CK, Tam YH, Ng WT, Yip KF. Laparoscopy for definitive diagnosis and treatment of gastrointestinal bleeding of obscure origin in children. J Pediatr Surg. 2000;35(9):1291–3.

    Article  CAS  PubMed  Google Scholar 

  42. Yau KK, Siu WT, Law BK, et al. Laparoscopy-assisted surgical management of obscure gastrointestinal bleeding secondary to Meckel’s diverticulum in a pediatric patient: case report and review of literature. Surg Laparosc Endosc Percutan Tech. 2005;15(6):374–7.

    Article  PubMed  Google Scholar 

  43. Murphy FJ, Mohee A, Khalil B, et al. Versatility of the circumumbilical incision in neonatal surgery. Pediatr Surg Int. 2009;25:145–7.

    Article  PubMed  Google Scholar 

  44. Scoutter AD, Askew AA. Transumbilical laparotomy in infants: a novel approach for a wide variety of surgical disease. J Pediatr Surg. 2003;38:950–2.

    Article  Google Scholar 

  45. Suri M, Langer JC. A comparison of circumumbilical and transverse abdominal incisions for neonatal abdominal surgery. J Pediatr Surg. 2011;46:1076–80.

    Article  PubMed  Google Scholar 

  46. St-Vil D, Brandt ML, Panic S, Bensoussan AL, Blanchard H. Meckel’s diverticulum in children: a 20-year review. J Pediatr Surg. 1991;26(11):1289–92.

    Article  CAS  PubMed  Google Scholar 

  47. Yahchouchy EK, Marano AF, Etienne JF, Fingerhut AL. Meckel’s diverticulum. J Am Coll Surg. 2001;192(5):658–61.

    Article  CAS  PubMed  Google Scholar 

  48. Cooney DR, Duszynski DO, Camboa E, Karp MP, Jewett TC Jr. The abdominal technetium scan (a decade of experience). J Pediatr Surg. 1982;17(5):611–9.

    Article  CAS  PubMed  Google Scholar 

  49. Swaniker F, Soldes O, Hirschl RB. The utility of technetium 99 m pertechnetate scintigraphy in the evaluation of patients with Meckel’s diverticulum. J Pediatr Surg. 1999;34(5):760–5.

    Article  CAS  PubMed  Google Scholar 

  50. Poulsen KA, Qvist N. Sodium pertechnetate scintigraphy in detection of Meckel’s diverticulum: is it usable? Eur J Pediatr Surg. 2000;10:228–31.

    Article  CAS  PubMed  Google Scholar 

  51. Rerksuppaphol S, Hutson JM, Oliver MR. Ranitidine enhanced 99 m technetium pertechnetate imaging in children improves the sensitivity of identifying heterotopic gastric mucosa in Meckel’s diverticulum. Pediatr Surg Int. 2004;20:323–5.

    CAS  PubMed  Google Scholar 

  52. Mackey WC, Dineen P. A fifty year experience with Meckel’s diverticulum. Surg Gynecol Obstet. 1983;156(1):56–64.

    CAS  PubMed  Google Scholar 

  53. Peoples JB, Lichtenberger EJ, Dunn MM. Incidental Meckel’s diverticulectomy in adults. Surgery. 1995;118(4):649–52.

    Article  CAS  PubMed  Google Scholar 

  54. Michas CA, Cohen SE, Wolfman EF Jr. Meckel’s diverticulum: should it be excised incidentally at operation. Am J Surg. 1975;129(6):682–685.

    Google Scholar 

  55. Mukai M, Takamatsu H, Noguchi H, et al. Does the external appearance of a Meckel’s diverticulum assist in choice of the laparoscopic procedure? Pediatr Surg Int. 2002;18(4):231–3.

    Article  PubMed  Google Scholar 

  56. Kittle SF, Jenkins HP, Dragstedt LR. Patent omphalomesenteric duct and its relation to the diverticulum of Meckel. Arch Surg. 1947;54:10–36.

    Article  CAS  PubMed  Google Scholar 

  57. Cullen JJ, Keith K, Moir C, Hodge D, Zinsmeister A, Melton J. Surgical management of Meckel’s diverticulum. Ann Surg. 1994;220:564–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Rubin A. A handbook of congenital malformations. Philadelphia (Pa): Saunders; 2009.

    Google Scholar 

  59. Patel PJ, Kolawole TM, Izzidien Al-Samarrai AY. Vesicourachal diverticulum in association with other urological anomalies. Eur Urol. 1987;13(6):417–8.

    Article  CAS  PubMed  Google Scholar 

  60. Ueno T, Hashimoto H, Yokoyama H, Ito M, Kouda K, Kanamaru H. Urachal anomalies: ultrasonography and management. J Pediat Surg. 2003;38(8):1203–7.

    Article  CAS  PubMed  Google Scholar 

  61. McCollum MO, MacNeily AE, Blair GK. Surgical implications of urachal remnants: presentation and management. J Pediatr Surg. 2003;38:798–803.

    Article  CAS  PubMed  Google Scholar 

  62. Mesrobian HG, Zacharias A, Balcom AH, et al. Ten years of experience with isolated urachal anomalies in children. J Urol. 1997;158:1316–8.

    Article  CAS  PubMed  Google Scholar 

  63. Begg RC. The urachus: its anatomy, histology and development. J Anat. 1930;64:170–83.

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Kluth D, Hillen M, Lambrecht W. The principles of normal and abnormal hindgut development. J Pediatr Surg. 1995;30:1143–7.

    Article  CAS  PubMed  Google Scholar 

  65. Parrot TS, Gray SW, Skandalakis JE. The bladder and urethra. In: Skandalakis JE, Gray SW, editors. Embryology for surgeons. 2nd ed. Philadelphia: Saunders.

    Google Scholar 

  66. Moore KL. The urogenital system. In: Moore KL, editor. The developing human. 3rd ed. Philadelphia: Saunders; 1982. p. 255–97.

    Google Scholar 

  67. Blichert-Toft M, Nielsen OV. Congenital patient urachus and acquired variants. Diagnosis and treatment. Review of the literature and report of five cases. Acta Chir Scand. 1971;137:807–14.

    CAS  PubMed  Google Scholar 

  68. Gearhart JP, Jeffs RD. Urachal abnormalities. In: Walsh PC, Retik AB, Vaughan ED, et al., editors. Campbell’s urology, 7th ed. Philadelphia WB Saunders; 1998. p. 1984-1987.

    Google Scholar 

  69. Little DC, Shah SR, St. Peter SD, et al. Urachal anomalies in children: the vanishing relevance of the preoperative voiding cystourethrogram. J Pediatr Surg. 2005;40(12):1874–6.

    Article  PubMed  Google Scholar 

  70. Lane V. Congenital patent urachus associated with complete (hypospadiac) duplication of the urethra and solitary crossed renal ectopia. J Urol. 1982;127:990–2.

    Article  CAS  PubMed  Google Scholar 

  71. Rich RH, Hardy BE, Filler RM. Surgery for anomalies of the urachus. J Pediatr Surg. 1983;18:370–3.

    Article  CAS  PubMed  Google Scholar 

  72. Berman SM, Tolia BM, Laor E, et al. Urachal remnants in adults. Urology. 1988;31:17–21.

    Article  CAS  PubMed  Google Scholar 

  73. Schubert GE, Pavkovic MB, Bethke-Bedurftig BA. Tubular urachal remnants in adult bladders. J Urol. 1982;127:40–2.

    Article  CAS  PubMed  Google Scholar 

  74. Ozel LZ, Talu M, User Y, et al. Coexistence of a Meckel’s diverticulum and a urachal remnant. Clin Anat. 2005;18(8):609–12.

    Article  CAS  PubMed  Google Scholar 

  75. Cuda SP, Vanasupa BP, Sutherland RS. Nonoperative management of a patent urachus. Urology. 2005;66(6):1320.

    Article  PubMed  Google Scholar 

  76. Osawa K, Ito M, Sugiyama M, et al. A case of fetal vesicoallantoic cyst in the umbilical cord. Fetal Diagn Ther. 2003;18(2):87–90.

    Article  PubMed  Google Scholar 

  77. Yeats M, Pinch L. Patent urachus with bladder eversion. J Pediatr Surg. 2003;38:E56.

    Article  PubMed  Google Scholar 

  78. Dorai CRT. Umbilical evagination of the bladder with omphalocele minor. Pediatr Surg Int. 2000;16:128–9.

    Article  Google Scholar 

  79. Lugo B, McNulty J, Emil S. Bladder prolapse through a patent urachus: fetal andneonatal features. J Pediatr Surg. 2006;41:E5–7.

    Article  PubMed  Google Scholar 

  80. Nobuhara KK, Lukish JR, Hartman GE, et al. The giant umbilical cord: an unusual presentation of a patent urachus. J Pediatr Surg. 2004;39(1):128–9.

    Article  PubMed  Google Scholar 

  81. Mata JA, Livne PM, Gibbons MD. Urinary ascites: complication of umbilical artery catheterization. Urology. 1987;30(4):375–7.

    Article  CAS  PubMed  Google Scholar 

  82. Rowe PC, Gearhart JP. Retraction of the umbilicus during voiding as an initial sign of a urachal anomaly. Pediatrics. 1993;91(1):153–4.

    CAS  PubMed  Google Scholar 

  83. Ozbek SS, Pourbagher MA, Pourbagher A. Urachal remnants in asymptomatic children: gray-scale and color Doppler sonographic findings. J Clin Ultrasound. 2001;29(4):218–22.

    Article  CAS  PubMed  Google Scholar 

  84. Yu JS, Kim KW, Lee HJ, et al. Urachal remnant diseases: spectrum of CT and US findings. Radiographics. 2001;21(2):451–61.

    Article  CAS  PubMed  Google Scholar 

  85. Risher WH, Sardi A, Bolton J. Urachal abnormalities in adults: the Ochsner experience. South Med J. 1990;83(9):1036–9.

    Article  CAS  PubMed  Google Scholar 

  86. Avni EF, Matos C, Diard F, et al. Midline omphalovesical anomalies in children: contribution of ultrasound imaging. Urol Radiol. 1988;10(4):189–94.

    Article  CAS  PubMed  Google Scholar 

  87. MacNeily AE, Koleilat N, Kiruluta HG, et al. Urachal abscesses: protean manifestations, their recognition, and management. Urology. 1992;40(6):530–535.

    Article  CAS  PubMed  Google Scholar 

  88. Masuko T, Nakayama H, Aoki N, et al. Staged approach to the urachal cyst with infected omphalitis. Int Surg. 2006;91(1):52–6.

    PubMed  Google Scholar 

  89. Minevich E, Wacksman J, Lewis AG, et al. The infected urachal cyst: primary excision versus a staged approach. J Urol. 1997;157(5):1869–72.

    Article  CAS  PubMed  Google Scholar 

  90. Cilento BG Jr, Bauer SB, Retik AB, et al. Urachal anomalies: defining the best diagnostic modality. Urology. 1998;52(1):120–2.

    Article  PubMed  Google Scholar 

  91. Fox JA, McGee SM, Routh JC, Granberg CF, Ashley RA, Hutcheson JC, Vandersteen DR, Reinberg YE, Kramer SA. Vesicoureteral reflux in children with urachal anomalies. J Pediatr Urol. 2011;7(6):632–5.

    Article  PubMed  Google Scholar 

  92. Cappele O, Sibert L, Descargues J, et al. A study of the anatomic features of the duct of the urachus. Surg Radiol Anat. 2001;23(4):229–35.

    Article  CAS  PubMed  Google Scholar 

  93. Pinthus JH, Haddad R, Trachtenberg J, et al. Population based survival data on urachal tumors. J Urol. 2006;175(6):2042–7. discussion 2047

    Article  PubMed  Google Scholar 

  94. Wright JL, Porter MP, Li CI, et al. Differences in survival among patients with urachal and nonurachal adenocarcinomas of the bladder. Cancer. 2006;107(4):721–8.

    Article  PubMed  Google Scholar 

  95. Rankin LF, Allen GD, Yuppa FR, et al. Carcinoma of the urachus in an adolescent: a case report. J Urol. 1993;150(5 Pt 1):1472–3.

    Article  CAS  PubMed  Google Scholar 

  96. Brick SH, Friedman AC, Pollack HM, et al. Urachal carcinoma. Radiology. 1988;169:377–81.

    Article  CAS  PubMed  Google Scholar 

  97. Beck AD, Gaudin JH, Bonhan GD. Carcinoma of the urachus. Br J Urol. 1970;42:555–62.

    Article  CAS  PubMed  Google Scholar 

  98. Mostofi FK. Potentialities of bladder epithelium. J Urol. 1954;71:705–14.

    Article  CAS  PubMed  Google Scholar 

  99. Cutting CW, Hindley RG, Poulsen J. Laparoscopic management of complicated urachal remnants. BJU Int. 2005;96(9):1417–21.

    Article  PubMed  Google Scholar 

  100. Peters CA. Laparoscopic and robotic approach to genitourinary anomalies in children. Urol Clin North Am. 2004;31(3):595–605.

    Article  PubMed  Google Scholar 

  101. Khurana S, Borzi PA. Laparoscopic management of complicated urachal disease in children. J Urol. 2002;168(4 Pt 1):1526–8.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Bruce Okoye MBBS, MD, FRCS(Paeds) .

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Sudhakaran, N., Okoye, B. (2018). Omphalomesenteric Duct and Urachal Remnants. In: Losty, P., Flake, A., Rintala, R., Hutson, J., lwai, N. (eds) Rickham's Neonatal Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-4721-3_47

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