Patent vitellointestinal duct with ileal prolapse in a newborn.

Sir,

Vitellointestinal or omphalomesenteric duct, which connects the primitive gut to the yolk sac usually obliterate around the seventh or eighth week of gestation. Failure to do this leads to several possible anomalies, including an omphalomesenteric fistula, an enterocyst, a fibrous band connecting the intestine to the umbilicus, or a Meckel's diverticulum with or without a fibrous cord connecting to the umbilicus.[1]

We report a case of patent vitellointestinal duct through which a loop of ileal segment had prolapsed outside the abdominal wall in a newborn. Totally patent vitellointestinal duct in a newborn is a very rare anomaly and one case with prolapse of both proximal and distal loop of intestine in a newborn has been reported in the literature.[2]

A term newborn male child born by normal delivery presented with prolapse of ileum through umbilicus with discharging mucus and fecal matter [Figure 1]. There was no history of vomiting or abdominal distension. There was no associated anomaly in ultrasonography of abdomen. Routine blood investigations were within normal limits. Laparotomy was performed by small curved infraumbilical incision under general anesthesia. The outer surface of the emerging loop was firmly adherent to all the layers of the anterior abdominal wall. It was dissected from the abdominal wall layers with the fine scissors. The distal loop entering into the umbilicus was slowly pulled inside the peritoneal cavity gently, to find that the outer loop was diminishing in size and finally disappeared. After complete reduction the patent vitellointestinal duct was excised and primary resection and anastomosis of ileum done. Umbilicus was reconstructed. Postoperative recovery and wound healing progressed without any complication and the patient was discharged on fifth postoperative day. He was followed-up for 3 months and was asymptomatic.

Figure 1

Ileal prolapse through patent vitellointestinal duct

Omphalomesenteric duct anomalies may be associated with umbilical hernia, intestinal atresia, cardiac malformation, cleft lip and palate, and exomphalos. It is also reported that the omphalomesenteric duct may be seen in trisomy 13 and Down's syndrome.[3] Intestinal obstruction is the most lethal complication of omphalomesenteric duct remnants.[4] For this reason, early diagnosis and surgical intervention is recommended to prevent serious complications such as intestinal gangrene and sepsis.

To conclude, patent vitellointestinal duct with prolapse of ileal loop in a newborn is a rare condition which needs prompt diagnosis, surgical reduction, and repair of the defect.