Neonatal intestinal volvulus due to a persistent right vitelline artery

Abstract

We report a case of neonatal intestinal volvulus around a persistent right vitelline artery, presenting as an aberrant parieto-mesenteric band on exploratory laparotomy. To our knowledge, this is the first case report in the English literature of a persistent right vitelline artery causing axial intestinal volvulus in a neonate. A review of the literature and the embryopathogenesis is discussed, as well as the importance of emergent diagnoses of such lesions.

A rare cause of intestinal obstruction in the newborn: Congenital band compression

“…Congenital bands can be in the form of omphalodiverticular, omphalomesenteric or mesodiverticular bands; simple bands with unknown origin have been also reported [2,6]. In the literature, 2 patients with congenital bands diagnosed at 8 days and 3 weeks of age, respectively, have been reported [7,8]. Both cases presented at hospital with vomiting and abdominal distension after they had been sent home following birth, and band compression due to Meckel diverticulum was found.…”

Intestinal Obstruction Due to Congenital Bands From Vitelline Remnants

“…Congenital bands are well‐established cause of intestinal obstruction, especially in children. The bands may represent the remnants of the omphalomesenteric duct (vitelline duct) or the vitelline vessels 2 – 6 . The vitelline remnant persists in approximately 2% of the population, with a higher incidence in boys 5 , 7 – 9…”

“…The vitelline vessel may also fail to obliterate and persist, and the remnant of the vessel is differentiated from the obliterated Meckel diverticulum because the vessel generally joins the mesentery, 5 – 7 antimesenteric border of the intestine, and even nearby structures 5 . The mechanisms of bowel obstruction due to a vitelline remnant include intussusception, a volvulus, and an internal hernia 2 , 6 , 12 – 18…”

“…Intestinal obstruction by congenital bands is difficult to diagnose preoperatively 1 , 2 . When abdominal radiographic findings are negative, the challenge is even greater.…”

Small Bowel Obstruction Caused by an Aberrant Congenital Band in a Child

“…The cause of a congenital band cannot be precisely determined. Embryonic remnants, such as vitelline vessels or omphalomesenteric ducts, can be differentiated according to their localization and pathologic findings [2,5]. On the other hand, a congenital band may be explained as remnants of ventral mesenterium that failed to reabsorb completely past the fourth week of gestation [2].…”