Laparoscopic treatment of intestinal obstruction due to a vitelline vascular remnant and simultaneous appendicitis: a case report

Abstract

BackgroundThe presence of a vitelline vascular remnant is rare, and definitive preoperative diagnosis is difficult. We herein describe a case of intestinal obstruction caused by a vitelline vascular remnant with mild chronic appendicitis successfully diagnosed and treated with laparoscopic surgery.Case presentationA 14-year-old male was admitted to our hospital with sudden-onset right lower abdominal pain and vomiting. A blood test on admission revealed slight leukocytosis. Computed tomography scan showed that the appendiceal wall was enhanced and thickened. Although the ileum was slightly dilated and ascites was present at the recto-vesical pouch, these were thought to be inflammatory changes secondary to appendicitis. Laparoscopic surgery was performed using three trocars. Strangulated small bowel obstruction caused by a band connecting the right medial umbilical fold to the ileal mesentery was found intraoperatively. After reduction, neither ischemic change of the small intestine nor Meckel’s diverticulum was detected. The appendix was slightly inflamed, and serous ascites was present at the recto-vesical pouch; therefore, appendectomy was also performed. The patient was discharged on postoperative day 4 without complications. Pathological examination revealed that the band consisted of blood vessels, and it was diagnosed as a vitelline vascular remnant. The appendix included fecal stones and showed chronic inflammatory change histologically; the patient was thus diagnosed with chronic appendicitis.ConclusionsDefinitive preoperative diagnosis of a vitelline vascular remnant, especially with coexisting appendicitis, might be difficult. Laparoscopic surgery might be useful for patients who demonstrate unusual symptoms because it allows for simultaneous diagnosis and treatment.

Anatomical Variations of Vascular Anatomy in Meckel’s Diverticulum

“…The patient presented with a fibrous ileal-mesenteric band not attached to MD. Along the same lines, Date et al and Jalil et al recorded a remnant of the vitelline artery without MD, where the former noticed simultaneous appendicitis (18,19). The remnant of the vitelline vein is infrequent and, according to Miyoshi et al, that variation has been described in only three cases in the literature (9,(20)(21)(22).…”

“…In terms of embryology, MD consists of three anatomical parts: the omphalomesenteric duct, two vitelline arteries and one vitelline vein ( 2 , 17 , 18 ). The left vitelline artery degenerates, whereas the right remains as the superior mesenteric artery, and is the main blood supply for the MD ( 2 ).…”

“…Other less common types of mucosa include pancreatic and duodenal. Heterotopic mucosa is associated with the presence of symptoms, so it has clinical significance: for instance, acid from the gastric mucosa cells can result in ileal ulceration, hemorrhage and inflammation ( 2 , 18 ). Furthermore, malignant neoplasms have been recorded that derive from the remnant omphalomesenteric duct ( 18 ).…”

Meckel’s diverticulitis with abscess presentation in an acute abdomen

“…USG and CT are commonly used for the evaluation of patients with complications such as obstruction and inflammation. [2][3][4] Mechanism of obstruction by Meckel's diverticulum is due to internal hernia secondary to a mesodiverticular band which runs from root of mesentery to antimesenteric border of diverticulum or by volvulus, it acts also as lead point for intussusception due to lymphoid hyperplasia at its base. [5] Meckel's diverticulitis usually mimics as appendicitis clinically.…”

A case of recurrent perianal abscess with fistula-in-ano treated with homoeopathy: A case report

“…Surgical excision of the vitelline duct or vessel remnant is the curative treatment and many cases were successfully treated by laparoscopic surgery. Date et al [9] and Hurni et al [10] were used laparoscopy successfully in the management of vitelline artery remnant.…”