Patent omphalomesenteric duct of the vermiform appendix in a neonate: congenital appendicoumbilical fistula

Abstract

Umbilical anomalies arise from fetal structures such as the omphalomesenteric duct (OMD) or urachus or from failure of closure of the umbilical fascial ring. Persistence of the OMD may lead to several anomalies including umbilical sinus, umbilical cyst, Meckel's diverticulum, or patent OMD (POMD). A POMD is usually associated with the ileum, but rarely may be with the caecum or appendix. We describe a POMD of the vermiform appendix and discuss the possible pathogenesis and management.

Vitellointestinal Duct Anomalies in Infancy

“…[4][5][6] Similar to our experience, most of the subject are symptomatic in the neonatal period. Two of the subjects presenting in neonatal age succumbed to neonatal sepsis and dyselectrolytemia.…”

“…Although MD is common OMD anomaly in children, it is rare in infancy. [5,6] In our study too only in one case MD was found.…”

“…[6,7] The patient may present with the anomaly itself or due to complications like intestinal obstruction secondary to volvulus, intussusceptions or adhesions. The patients presenting with bowel prolapse along with intussusception require emergent intervention to avoid gut ischemia.…”

Patent omphalomesenteric duct opening into the vermiform appendix

“…The most frequently seen of the aforementioned spectrum of findings is the Meckel's diverticulum and it is reported to be present in only 2-3% of people [5], and to be more symptomatic in males. The appendico-umbilical fistula is believed to be a variant of the patent omphalomesenteric duct, one that connected with the appendix instead of the distal ileum or other places like the cecum or the ascending colon [2], and that indeed is the diagnosis in this case.…”

“…These anomalies are in a spectrum and present in various forms, ranging from the infamous Meckel's diverticulum to a fibrous nonpatent connection between the umbilicus and the distal ileum, to a patent connection between the umbilicus and the intestine, the patent omphalomesenteric duct. It is normally observed as a connection with the distal ileum but has been known to connect with the cecum, ascending colon and the appendix [2,3]. We present the case of a two-month-old female child who was referred to us with complaints of failure of healing of the umbilical stump and the discharge of intestinal contents via the umbilicus.…”