Omphalocele with Double Prolapse of Ileum through Patent Vitellointestinal Duct: A Rare Presentation

Abstract

Although Meckel's diverticulum is the most common vitellointestinal duct (VID) anomaly, patent vitellointestinal duct (PVID) is the most common symptomatic embryological defect. Patient may present with the anomaly itself or due to complications like intestinal obstruction secondary to volvulus, intussusception or adhesions. Prolapse occurs if the diverticulum is wide-mouthed enough to allow bowel to come out or due to increased intra-abdominal pressure like cry or cough. Bowel prolapse through PVID is rare and double prolapse of proximal as well as distal loop in a newborn is extremely rare. Omphalocele with prolapsing bowel through PVID as found in our index case is even rarer in literature. The pediatric surgeon should be familiar with these varied manifestations in the newborn because the prolapsed bowel can progress to gangrene and complications if not identified and operated upon early.

Complete evagination of a patent vitellointestinal duct and adjacent ileal limbs from an omphalocele sac: an extreme presentation

“…After a thorough review of the available literature, we discovered only eight similar case reports spanning from 1952 to present (table 1). 9–16…”

Inverted Proximal Ileal Loop Prolapse with Ileal Rupture through a Patent Omphalomesenteric Duct: A Rare Case

“…The incidence of the patent omphalomesenteric duct is reported to be 1 in 5000 to 8000 newborns (approximately 2% of the population) and may begin at birth or occur within 1 to 2 weeks after delivery [6], [12]. This is suitable in our case, in which the mother admitted the appearance of unusual-red-coloured mass from the umbilicus on the first week after vaginal delivery [13].…”

“…Intussusception, volvulus, internal hernia (closed-loop obstruction) from the POMD, and a fibrous connection between umbilicus and ileum are the mechanisms of POMD causing small bowel obstruction [3], [4], [7], [10]. Meanwhile, the mechanisms of ileal prolapse through umbilicus is hypothesized by these two reasons, such as the wide mouth of the patent duct and the short distance between the patent duct and ileocecal valve in infants leading to high intraluminal pressure [2], [4], [5], [10], [12]. Besides, these conditions are exacerbated by the increased intraabdominal pressure, such as cry or cough [12].…”

“…Meanwhile, the mechanisms of ileal prolapse through umbilicus is hypothesized by these two reasons, such as the wide mouth of the patent duct and the short distance between the patent duct and ileocecal valve in infants leading to high intraluminal pressure [2], [4], [5], [10], [12]. Besides, these conditions are exacerbated by the increased intraabdominal pressure, such as cry or cough [12]. In our case, rupture of ileum happened as the compensation of increased intraluminal pressure caused by the end of the POMD pathogenesis, such as the small bowel obstruction.…”

“…The OMDR occurs in approximately 2% of newborns and in 6% of these the duct remains patent, with only 20% of patent omphalomesenteric duct cases being complicated by intussusception of small bowel through the patent duct. Males are thrice more prone to be in this condition, and 73% of this case exhibit symptoms within the first 28 days of life [2], [6], [10], [11], [12], [13], [14].…”