Patent Vitellointestinal Duct with Inverted Ileal Loop Prolapse with Strangulation at Birth in Preterm (34 Weeks): A Rare Presentation

Abstract

Journal of Surgery IntroductionDuring the fifth to seventh week of gestation, midgut enlarges rapidly and as it becomes too large for the abdominal cavity, it herniates through the umbilical cord. The apex of the herniated midgut is continuous with VID and yolk sac. Superior mesenteric artery forms the axis of this herniated midgut. Around tenth week of gestation herniated midgut returns back into the peritoneal cavity [1,2]. During this complex developmental process several anomalies may occur because of the complexity of the process. Examples include bowel atresias and stenoses, abnormalities of the vitellointestinal duct (Meckel's diverticulum, patent vitellointestinal duct (PVID), umbilical fistulas, umbilical sinus tracts, umbilical cysts and umbilical polyps), failure of ceacal descent, malrotation, malfixation, reversed bowel rotation and exomphalos [1][2][3]. VID is more common in males and mostly presents in first 28 days of life. This anomaly needs to be managed urgently to prevent gangrene. Case PresentationA male neonate delivered via LSCS (CAUSE-PREVIOUS LSCS) which was unbooked delivery 34 weeks with LMP-3/12/16 and EDD-10/9/17 WITH G4P3L3A1 was admitted in Yashoda Hospital, Ghazaibad, U.P. Baby was born at preterm. Antenatal scans were reported to be abnormal showing anterior wall depressed-pouch and part of intestine coming out from umbilicus. Birth weight was 2250 g and Apgar scores were 8/1, 9/1, 10/10. On examination at birth, newborn was having respiratory distress and grunting, so oxygen was started immediately and chest x-ray and arterial blood gas (ABG) was done. Chest x-ray showed grade 2 Hyaline Membrane Disease (HMD) and ABG showed respiratory acidosis, for which child was intubated and ventilated, also received surfactant. Abdominal examination revealed a bright red 'Y' shaped loop of small intestine was protruding from the umbilical ring. It was fixed to the umbilicus, with easily bleeding mucosa and irreducibility. Rest of the abdomen was not distended non tender (Figures 1 and 2). Bowel sounds were absent. There was no bilious aspirate in the orogastric tube. Anal opening was normally placed and patent, however, he had not passed any meconium. Patient had passed clear urine twice and the bladder was not palpable. Rest of the systemic examination was normal. AbstractPatent vitellointestinal duct (VID) can present to us in many variety of congenital intestinal malformations. Patient presents with either anomaly alone or complications secondary to the anomaly. Most common reported anomaly of residual vitelline duct is Meckel's diverticulum with different presentations like bleeding, intestinal obstruction or diverticulitis. Prolapsed ileal loops through a patent VID is a rare presentation of the above. To date only fifteen cases of this presentation have been reported in the English medical literature but none reported in a premature newborn baby presenting with it from the time of birth, which to the best of our knowledge has not been reported before and therefore this the youngest r...

Intestinal prolapse through the patent vitellointestinal duct in a preterm newborn

“…[5][6][7] The clinical presentation is variable with very few reported cases of this entity presented at birth and most of the clinical presentations were beyond the first day of life or after neonatal period. [1,7,8] It may later present with sudden evisceration of intestine (prolapse) from umbilicus while the baby is crying and if the condition not managed promptly by surgical intervention, may lead to intestinal obstruction, strangulation and gangrene of the prolapsed intestine. [3,5] To the best of our knowledge, there are only a few case reports of prolapsing PVID in preterm newborns presenting at birth.…”

“…[3,5] To the best of our knowledge, there are only a few case reports of prolapsing PVID in preterm newborns presenting at birth. [7,9] The outcome is highly dependent on the time of presentation, early diagnosis, complications (strangulation), and associated anomalies. [7] We believe that PVID need prompt diagnosis and repair as soon as possible to avoid risk of bowel prolapse, ischemia, gangrene, or obstruction.…”