OMPHALOMESENTERIC (VITELLINE) REMNANT

 

OMPHALOMESENTERIC (VITELLINE) REMNANT

Partial or complete failure of involution of the omphalomesenteric duct can lead to a spectrum of anomalies in the newborn infant due to varying degrees and location of duct patency:

A.   An umbilical cyst containing intestinal tissue.

B.   Umbilical sinus with a band.

C.   A persistent omphalomesenteric duct at the umbilicus with no intestinal connection results in an umbilical polyp.

D.   Patent mid-duct with closure at both the umbilical and ileal ends of the omphalomesenteric duct results in an omphalomesenteric duct cyst. Because the two ends are fixed, this can lead to small bowel obstruction if loops of bowel twist around the cyst.

E.   Persistent tissue at the ileum, with no connection to the umbilicus results in Meckel's diverticulum.

F.   Complete patency results in the omphalomesenteric duct directly connecting the umbilicus to the terminal ileum. This can lead to intermittent drainage from the umbilicus " omphalomesenteric fistula". These infants will often appear to have a "stoma" in the umbilicus after cord separation.

G.  Persistent fibrous cord (band)  between the umbilicus and the ileum, which can lead to small bowel obstruction.

Clinical manifestations:

Although OMD remnants are usually asymptomatic, 40 % of these lesions may present with symptoms, including gastrointestinal bleeding, intestinal obstruction, and umbilical abnormalities, depending on the specific type of defect.

Abdominal pain and bilious umbilical drainage were much less common.

The simultaneous presence of more than 1 anomaly of OMD in the same patient has also been reported.