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Background Patent omphalomesenteric duct is one of the birth defects included in the spectrum of vitelline duct abnormalities. It is a rare anomaly with estimated prevalence of 0.13–0.2% in the general population. The most common presentation of patent vitelline duct is yellowish or mucoid type umbilical discharge which is usually noted in neonatal age or infancy. The main stay of diagnosis is clinical and outcome is favorable as long as timely surgical correction is offered. Here we present a 2 years old male child who presented with ileal prolapse through patent vitelline duct which is an exceptional mode of presentation of this pathology. Case presentation 2 years old Ethiopian male child who was noticed to have umbilical discharge since early infancy presented with protrusion of pinkish mass per the umbilicus of 4 h duration. He had no signs and symptoms of bowel obstruction. Abdominal examination revealed a prolapsed bowel which was viable via the umbilicus which was about 6 cm long. Otherwise, he had no abdominal tenderness or rigidity. He was explored with a smiley incision just above the umbilicus. The prolapsed bowel was reduced gently to the abdominal cavity. The tract of the Patent vitelline duct was identified and completely resected along with a wedge of ileum at its base. Primary repair of the ileal end where the tract was inserted was done in two layers and abdomen was closed in layers. The child had smooth post op course and was discharged on the 4th post-operative day. Conclusion Prolapse of a bowel through the umbilicus is unusual presentation of a rare anomaly namely patent vitelline duct. This presentation warrants early surgical intervention before bowel ischemia issues. Hence, all clinicians dealing with children should be aware of this rare pathology so that urgent surgical management can be offered.
Background Patent omphalomesenteric duct is one of the birth defects included in the spectrum of vitelline duct abnormalities. It is a rare anomaly with estimated prevalence of 0.13–0.2% in the general population. The most common presentation of patent vitelline duct is yellowish or mucoid type umbilical discharge which is usually noted in neonatal age or infancy. The main stay of diagnosis is clinical and outcome is favorable as long as timely surgical correction is offered. Here we present a 2 years old male child who presented with ileal prolapse through patent vitelline duct which is an exceptional mode of presentation of this pathology. Case presentation 2 years old Ethiopian male child who was noticed to have umbilical discharge since early infancy presented with protrusion of pinkish mass per the umbilicus of 4 h duration. He had no signs and symptoms of bowel obstruction. Abdominal examination revealed a prolapsed bowel which was viable via the umbilicus which was about 6 cm long. Otherwise, he had no abdominal tenderness or rigidity. He was explored with a smiley incision just above the umbilicus. The prolapsed bowel was reduced gently to the abdominal cavity. The tract of the Patent vitelline duct was identified and completely resected along with a wedge of ileum at its base. Primary repair of the ileal end where the tract was inserted was done in two layers and abdomen was closed in layers. The child had smooth post op course and was discharged on the 4th post-operative day. Conclusion Prolapse of a bowel through the umbilicus is unusual presentation of a rare anomaly namely patent vitelline duct. This presentation warrants early surgical intervention before bowel ischemia issues. Hence, all clinicians dealing with children should be aware of this rare pathology so that urgent surgical management can be offered.
The persistent vitellointestinal duct is the rarest of all vitelline duct anomalies. This systematic literature review was undertaken to investigate and review the demographics, clinical presentation, surgical procedure performed, and outcome of infants who were operated upon for the persistent vitellointestinal duct. Infants with incomplete desired details, and children/cases operated upon for the above-mentioned anomaly after infancy were excluded. Published literature/manuscripts were retrieved for the previous fifty years from 1971 to December 2021, and the manuscripts were retrieved through an online database search. This review is presented in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A total of n = 280 infants who were operated upon for the patent vitelline duct were recruited for the systematic review. More than three-fourths (n = 217, 77.5%) of infants were boys. Ninety percent of infants were under the age of 3 months, and 72% were neonates/newborn babies. Discharges through the umbilicus (n = 148; 52.85%), and prolapse of the bowel through the umbilicus (n = 117; 41.78%) were the chief complaints in the above-mentioned infants. Operative procedures were performed (n = 280) in the following order of frequency: (1) resection of the persistent vitellointestinal duct, small adjacent segment of ileum, and ileo-ileal anastomosis (n = 121, 43.21%); (2) resection of the persistent vitellointestinal duct, wedge resection of ileum, and ileal repair (n = 88; 31.42%); and (3) other surgical procedures (n = 11, 3.92%). Operative details were not clear/not available/not provided for n = 60 (21.42%) of the infants. Peri-umbilical incisions were more frequently employed for surgical therapy. This review revealed postoperative death in n = 17 (6.07%) infants. The persistent vitellointestinal duct must be surgically resected at the earliest, preferably during the neonatal period.
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