Persistent Omphalomesenteric (Vitelline) Artery Causing Intestinal Obstruction and Gangrene of Meckelʼs Diverticulum

Abstract

AMONG THE RARER CONDITIONS which are encountered in surgery those which precipitate practical problems are especially worthy of consideration. Persistent omphalomesenteric, or vitelline, artery falls into this category. Its presence is one of the infrequent causes of intestinal obstruction. The literature contains only i6 cases in which a persistent omphalomesenteric artery caused symptoms, and, of this number, evidence of intestinal obstruction was found at operation or autopsy in ii cases (69 per cent). In addition, six asymptomatic cases have been reported, making a total of 22 cases of persistent omphalomesenteric artery in the literature.Of these 22 cases, a Meckel's diverticulum of the ileum was present in I3(59 per cent). Of the ii cases presenting evidence of intestinal obstruction at operation or autopsy, IO (9I per cent) had a coexistent Meckel's diverticulum. This association is not surprising if we consider the origins and fates of these structures in the embryo.EMBRYOLOGY 1,2,4,13,18,26,26 The yolk sac is demonstrable at the second week of intra-uterine life. The yolk sac and the primitive gut are connected to each other by the yolk-stalk, or vitelline (omphalomesenteric) duct. The part of the gut to which the omphalomesenteric duct is attached is the midgut; from it are derived the small intestine (except the first part of the duodenum), the cecum, the ascending colon and the transverse colon.During the first weeks of embryonal development, the aorta is a paired structure (Fig. i). From each portion a prominent vessel courses ventrally to the primitive gut and thence out along the yolk-stalk to reach the yolk sac. With the merging of the paired aorta into a single aorta the two main ventral branches merge and the resultant vessel comes to be the superior mesenteric artery (Figs. 2 and 3

Meckel’s Diverticulum With Persistent Omphalomesenteric Artery- A Case Report

“…We reported a patulous artery within the cord uncovered by peritoneum, attaching the Meckel's diverticulum to the ileal mesentery. Its incidence being 32% as reported by previous authors 3 The first case of persistent omphalomesenteric artery was reported by Sandifort in 1777. Meckel, in 1809, reported a case ,and was the first writer to suspect the true origin of this condition.…”

“…1 It is well to know, however that it may be one of the underlying causes of intraabdominal pathology that one may occasionally encounter. 3 From the review of literature analysis of above case report, the surgeon must always bear in mind the possibility that Meckel's diverticulum with a persistent omphalomesenteric artery may be the aetiological factor in any acute abdominal emergency,especially when specific diagnosis is difficult. The present paper will highlight the embryological basis and related clinical implications of the Meckel's diverticulum with persistent artery.…”

“…Fitz in 1884 gave an excellent resume of the cases reported upto that date, disproved the view that these bands were inflammatory in origin, and clearly described the manner they arose. 3 Clinical manifestations of this condition includes acute intestinal obstruction, recurrent abdominal pain and intraabdominal haemorrhage, gangrene of Meckel's diverticulum as a result of torsion of its neck contributed to, and maintained by, a taut omphalomesenteric artery. The diagnosis of Meckel's diverticulum with omphalomesenteric artery requires meticulous angiographic technique and a high index of suspicion.…”

“…2 It is one amongst those rarer conditions which are encountered in surgery and precipitate practical problems worthy of consideration. 3 Isolated Meckel's diverticulum has been reported in literature by many authors but meckel's diverticulum with persistent artery is rare. 4,5 Here we report a case of Meckel's diverticulum with persistent omphalomesenteric artery and review the current literature, embryological basis of this forgotten entity for its clinical diversity, diagnostic difficulty and management controversies.…”

Meckel's diverticulum: A review

“…The foregut gives rise to the first portion of the duodenum, while the hindgut derives the last one‐third of the transverse colon, the descending and sigmoid colon. By the 6th week, the yolk sac and yolk stalk disappear, along with the vitelline arteries (Manning and McLaughlin, 1947).…”