Abstract
The omphalomesenteric duct (OMD) is the embryonic structure connecting the primary yolk sac to the embryonic midgut. In normal circumstances it becomes a thin fibrous band, which eventually disintegrates and is absorbed spontaneously at the fifth to tenth week of gestation. The omphalomesenteric duct will continue to grow if it fails to disintegrate completely; failure of such closure may result in the OMD remnants. There are many mechanisms for small-bowel obstruction from a persistent omphalomesenteric duct; these include intussusception in the case of a patent omphalomesenteric duct, volvulus or internal hernia (closed-loop obstruction) from a patent omphalomesenteric duct or a fibrous connection between the umbilicus and the ileum. A patent OMD and Meckel’s diverticulum are clinically significant because they may lead to intestinal obstruction. In general, the most appropriate treatments of small-bowel obstruction as well as timing of surgery remain controversial. A lot of confusion exists not only in literatures but also in textbooks dealing with theses anomalies, about the presentation and classification, so we will try to explain each anomaly, in a simple way, with a new classification covering the common anomalies as well as the rare case reported. Midgut prolapse and congenital umbilical appendix are rare entities related to vitellointestinal duct anomalies, reported separately, but I included it herein with the other known anomalies.
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References
Kittle CF, Jenkins HP, Dragstedt LR. Patent omphalomesenteric duct and its relation to the diverticulum of Meckel. Arch Surg. 1947;54:10–36.
Larsen W. Human embryology. 2nd ed. New York: Churchill Livingstone; 1997. p. 240–2.
Trimingham HL, McDonald J. Congenital anomalies in the umbilicus. Surg Gynecol Obstet. 1945;80:152–63.
Nix TE Jr, Young JC. Congenital umbilical anomalies. Arch Dermatol. 1964;90:160–5.
Aitken J. Remnants of the vitellointestinal duct; a clinical analysis of 88 cases. Arch Dis Child. 1953;28(137):1–7. PMCID: PMC1988648.
Markogiannakis H, Theodorou D, Toutouzas KG, Drimousis P. Persistent omphalomesenteric duct causing small bowel obstruction in an adult. World J Gastroenterol. 2007;13(15):2258–60.
Ghislain P, Diane C, Christophe A, Xavier C. Intestinal prolapse through a persistent omphalomesenteric duct causing small-bowel obstruction. S Afr J Surg. 2012;50(3):102–3. doi:10.7196/SAJS.1289.
Sánchez-Castellanos M, Sandoval-Tress C, Hernández-Torres M. Persistencia del conducto onfalomesentérico. Diagnóstico diferencial de granuloma umbilical en la infancia. Actas Dermosifiliogr. 2006;97:404–5.
Griffith GL, et al. Patent urachus associated with completely patent Omphalomesenteric duct. South Med J. 1982;75(2):252. doi:10.1097/00007611-198202000-00041.
Ioannidis O, et al. Coexistence of multiple omphalomesenteric duct anomalies. J Coll Physicians Surg Pak. 2012;22(8):524–6. doi: 08.2012/JCPSP.524526.
Blair SP, Beasley SW. Intussusception of vitello-intestinal tract through an exomphalos in trisomy 13. Pediatr Surg Int. 1989;4:422–3.
Bargman H, Stewart WD. A case of Ehlers-Danlos syndrome (type IV) with persisting vitelline duct cyst. Cutis. 1980;25(4):411–4.
Miller G, Boman J, Shrier I, et al. Etiology of small bowel obstruction. Am J Surg. 2000;180:33–6.
Heider R, Warshauer DM, Behrns KE. Inverted Meckel‘s diverticulum as a source of chronic gastrointestinal blood loss. Surgery. 2000;128:107–8. [PubMed].
Meckel JF. Über die Divertikel am Darmkanal. Arch Physiol. 1809;9:421–53.
Coetzee T. Clinical anatomy of the umbilicus. S Afr Med J. 1980;57(12):463–6.
Hayashi A, et al. Severe acute abdomen caused by symptomatic Meckel’s diverticulum in three children with trisomy 18. Am J Med Genet A. 2015;167A:2447–50.
Teitelbaum DH, et al. Laparoscopic diagnosis and excision of Meckel’s diverticulum. J Pediatr Surg. 1994;29(4):495–7.
Ameh EA, et al. Symptomatic vitelline duct anomalies in children. S Afr J Surg. 2005;43(3):84–5.
Yamada T, Seiki Y, Ueda M, Yoshikawa T, Sempuku S, Kurokawa A, Nakata K. Patent omphalomesenteric duct: a case report and review of Japanese literature. Asia Oceania J Obstet Gynaecol. 1989;15(3):229–36.
Grosfeld JL, Franken EA. Intestinal obstruction in the neonate due to vitelline duct cysts. Surg Gynecol Obstet. 1974;138(4):527–32.
Heifetz SA, Eugenia Rueda-Pedraza M. Omphalomesenteric duct cysts of the umbilical cord. J Pediatr Pathol. 1983;1(3):325–35.
Templeton AW, Shebesta E. Communicating vitelline duct cyst. Radiology. 1964;82(3):476–7. doi:10.1148/82.3.476.
Schillings GJ. Strangulation ileus caused by a not completely obliterated omphaloenteric duct in a 32-year-old patient. Zentralbl Chir. 1987;112(6):383–6.
Kamii Y, Zaki AM, Honna T, Tsuchida Y. Spontaneous regression of patient omphalomesenteric duct: from a fistula to Meckel’s diverticulum. J Pediatr Surg. 1992;27(1):115–6.
Mahato NK. Obliterated, fibrous omphalomesenteric duct in an adult without Meckel’s diverticulum or vitelline cyst. Romanian J Morphol Embryol. 2010;51(1):195–7.
Mohite PN, Bhatnagar AM, Hathila VP, Mistry JH. Patent vitellointestinal duct with prolapse of inverted loop of small intestine: a case report. J Med Case Rep. 2007;1:49.
Sherer DM, Dar P. Prenatal ultrasonographic diagnosis of congenital umbilical hernia and associated patent omphalomesenteric. Gynecol Obstet Investig. 2001;51(1):66–8. doi:10.1159/000052895.
Collins DC. A study of 50,000 specimens of the human vermiform appendix. Surg Gynecol Obstet. 1955;101(4):437–45.
Ola Olorun AD, Adesina SA, Adepoju AO, Amole IO. Patent omphalomesenteric duct opening into the vermiform appendix. Int J Case Rep Images. 2015;6(12):743–6.
Fuijkschot J, Wijnen RM, Gerrits GP, Dubois SV, Rieu PN. A neonate with an intact congenital umbilical appendix: an alternative theory on the etiology of the appendico-umbilical fistula. Pediatr Surg Int. 2006;22(8):689–93.
Borgna Pignatti C, Bergamo Andreis I, Bettili G, Zamboni G. Delayed separation of an appendix containing umbilical stump. J Pediatr Surg. 1995;30:1717–8.
Sauerbrei E, et al. Ultrasound demonstration of the normal fetal yolk sac. J Clin Ultrasound. 1980;8(3):217–20. doi:10.1002/jcu.1870080306. Source: PubMed.
Srinivas GN, Cullen P. Intestinal obstruction due to Meckel’s diverticulum:a rare presentation. Acta Chir Belg. 2007;107:64–6.
Vane DW, West KW, Grosfeld JL. Vitelline duct anomalies. Experience with 217 childhood cases. Arch Surg. 1987;122:542.
Nursal TZ, et al. Laparoscopic resection of patent omphalomesenteric duct in an adult. Surg Endosc. 2002;16(11):1638. doi:10.1007/s00464-002-4209-2.
Dioufa C, Ndoyeb NA, Fayeb AL, Ndourb O, Ngomb G. Intestinal prolapse through omphalomesenteric fistula, a rare cause of neonatal occlusion: a case report. J Pediatr Surg Case Rep. 2016;10:1–2.
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Fahmy, M. (2018). Vitellointestinal Duct Anomalies. In: Umbilicus and Umbilical Cord. Springer, Cham. https://doi.org/10.1007/978-3-319-62383-2_36
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DOI: https://doi.org/10.1007/978-3-319-62383-2_36
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