Spectrum of Omphalomesenteric Duct Related Anomalies and Their Surgical Management in Children

Abstract

Objective The aim of this study was to evaluate the clinical presentation and surgical management of omphalomesenteric duct (OMD) remnants in children. Material and methods A descriptive retrospective study was conducted at the Department of Paediatric Surgery of the National Institute of Child Health, Karachi, Pakistan, from April 2017 to January 2020. Children below 12 years of age with various OMD remnants were included in the study. Data regarding age of presentation, type of anomaly, and management collected during this period were reviewed and analyzed using SPSS Version 22 (IBM Corp., Armonk, NY, USA). Results A total of 86 patients, 47 males and 39 females, were managed during the study period. Intestinal obstruction was observed in 44 (51.16%) cases followed by OMD-related umbilical anomalies in 14 (16.27%) cases, acute abdominal pain in 12 (13.95%), rectal bleeding in 3 (3.48%) patients. In 13 (15.16%) cases, Meckel’s diverticulum was discovered incidentally. In 21 cases, wedge resection and ileal repair was performed, whereas 32 required segmental resection and end-to-end anastomosis, and in 32 cases ileostomy was created after resection. Histopathology showed the presence of ectopic mucosa in five cases. Conclusion Patients with OMD remnants had various presentations. The surgical procedure has to be tailored according to the clinical and surgical findings.

Obstrucción intestinal secundaria a remanente del conducto onfalomesentérico: a propósito de un caso

“…El conducto onfalomesentérico, también llamado conducto vitelino, es una estructura embrionaria vital que actúa como fuente principal de nutrición para el feto, junto con la arteria y la vena vitelina. Genera una conexión estructural entre el saco vitelino con el intestino medio embrionario durante el desarrollo fetal, y el cierre fisiológico ocurre de manera espontánea entre la quinta y la novena semanas de gestación, pasando a ser una banda fibrosa delgada que se oblitera y se separa del intestino 1,2 .…”

Various Clinical Manifestation of Omphalomesenteric Duct Remnant in a Child: A Case Report

“…Omphalomesenteric duct (OMD) remnant is a condition in which the omphalomesenteric duct fails to obliterate completely or partially (Muniraman, Sardesai, and Sardesai 2018). The fate of the omphalomesenteric duct should be obliterated in the ninth week of gestation, but failure on this step can produce various patterns such as vitelline cyst, umbilical sinus, polyp, Meckel's diverticulum, and patent OMD (Muniraman et al 2018) (Azhar et al 2021). Clinical presentations that occur frequently are gastrointestinal bleeding, intestinal obstruction, and umbilical abnormalities (Muniraman et al, 2018).…”

“…Meanwhile, findings of completely patent OMD are approximately 0.0063-0.067% (Agrawal and Memon 2010). Clinical presentation of OMD remnant may vary from intestinal obstruction, abdominal pain, umbilical anomalies, and rectal bleeding(Azhar et al 2021). However, simultaneous clinical presentations are rarely reported(Muniraman et al, 2018).…”