Letters to the Editor Patent vitellointestinal duct with ileal prolapse in a newborn Sir, Vitellointestinal or omphalomesenteric duct, which connects the primitive gut to the yolk sac usually obliterate around the seventh or eighth week of gestation. Failure to do this leads to several possible anomalies, including an omphalomesenteric fistula, an enterocyst, a fibrous band connecting the intestine to the umbilicus, or a Meckel’s diverticulum with or without a fibrous cord connecting to the umbilicus. We report a case of patent vitellointestinal duct through which a loop of ileal segment had prolapsed outside the abdominal wall in a newborn. Totally patent vitellointestinal duct in a newborn is a very rare anomaly and one case with prolapse of both proximal and distal loop of intestine in a newborn has been reported in the literature. A term newborn male child born by normal delivery presented with prolapse of ileum through umbilicus with discharging mucus and fecal matter [Figure 1]. There was no history of vomiting or abdominal distension. There was no associated anomaly in ultrasonography of abdomen. Routine blood investigations were within normal limits. Laparotomy was performed by small curved infraumbilical incision under general anesthesia. The outer surface of the emerging loop was firmly adherent to all the layers of the anterior abdominal wall. It was dissected from the abdominal wall layers with the fine scissors. The distal loop entering into the
umbilicus was slowly pulled inside the peritoneal cavity gently, to find that the outer loop was diminishing in size and finally disappeared. After complete reduction the patent vitellointestinal duct was excised and primary resection and anastomosis of ileum done. Umbilicus was reconstructed. Postoperative recovery and wound healing progressed without any complication and the patient was discharged on fifth postoperative day. He was followed-up for 3 months and was asymptomatic. Omphalomesenteric duct anomalies may be associated with umbilical hernia, intestinal atresia, cardiac malformation, cleft lip and palate, and exomphalos. It is also reported that the omphalomesenteric duct may be seen in trisomy 13 and Down’s syndrome. Intestinal obstruction is the most lethal complication of omphalomesenteric duct remnants. For this reason, early diagnosis and surgical intervention is recommended to prevent serious complications such as intestinal gangrene and sepsis. To conclude, patent vitellointestinal duct with prolapse of ileal loop in a newborn is a rare condition which needs prompt diagnosis, surgical reduction, and repair of the defect.
Dipankar Roy, Rishavdeb Patra, Sunil Saxena Department of Neonatal and Paediatric Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karmani Memorial Hospital, Kolkata, West Bengal, India Address for correspondence: Dr Rishavdeb Patra, BH-36, Sector-2, Salt Lake City, Kolkata - 700 091, West Bengal, India. E-mail: [email protected]
REFERENCES 1. Stone PA, Hofeldt MJ, Campbell JE, Vedula G, DeLuca JA, Flaherty SK. Meckel diverticulum: Ten-year experience in adults. South Med J 2004;97:1038-41. 2. Borkar N. A Prolapsing vitello-intestinal Duct in Newborn. APSP J Case Rep 2013;4:32. 3. Blair SP, Beasley SW. Intussusception of vitello-intestinal tract through an exomphalos in Trisomy 13. Pediatr Surg Int 1989;4:422-3. 4. Hyman N, LeLeiko NS, Dolgin S. The curious umbilicus: Clue to the cause of abdominal pain. J Pediatr Gastroenterol Nutr 1991;13:90-1. Access this article online Website: www.jiaps.com
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Figure 1: Ileal prolapse through patent vitellointestinal duct 98
Journal of Indian Association of Pediatric Surgeons / Apr-Jun 2015 / Vol 20 / Issue 2
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