MyPACS.net: Radiology Teaching Files > Case 312303

never visited PATENT OMPHALOMESENTERIC DUCT
Contributed by: Children's Hospital Omaha, Radiologist, Omaha Childrens, Creighton University and UNMC, Nebraska, USA.
Patient: 2 day old male
History:

2-day old male who was found to have four ostia at the
time of insertion of umbilical arterial and venous catheters.
The study was done to evaluate for patent omphalomesenteric duct.

Images:[small]larger

Fig. 1: Scout image

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6: Vitelline duct remnant resection, beginning of dissection through infraumbilical incision. Umbilical arteries and urachus are ligated individually. Catheter is in umbilical vein. Umbilical stalk is bridging over hemostat.

Fig. 7: Vitalline duct remnant through periumbilical incision

Fig. 8: Vitelline duct remnant with artery, off antimesenteric border of ileum

Fig. 9: Vitelline duct remnant, stapled at its base on ileum

Fig. 10: Full thickness small bowel

Fig. 11: Small bowel submucosa

Fig. 12: Small bowel mucosa
Findings:

Under fluoroscopic guidance a total of 5.0 ml Omnipaque 300
contrast was injected through the umbilical catheter,
opacifying multiple loops of non-dilated small bowel located
within the left hemi-abdomen. There is retrograde
opacification of a small tract leading to the umbilicus, which
most likely represents a patent omphalomesenteric duct. The unusual
aspect of this lesion, however, is the fact that the
communication appears to be with the more proximal appearing
ileum, which is definitely located to the left of the midline.

Diagnosis:

Patent Omphalomesenteric Duct.

Discussion:

Congenital Omphalomesenteric Anomalies- Patent Omphalomesenteric Duct

- Other vitelline duct anomolies include Meckel's diverticulum (90%), Umbilical (vitelline) sinus, and umbilical (vitelline)
- Presentation: Neonatal umbilical discharge or additional umbilical ostia identified at birth
- Differential Diagnosis: Granulation tissue, retained umbilical cord elements, and infection or patency of urachal or omphalomesenteric ducts
- Imaging: Fluoroscopic sinus tract study for visualization of fistulous tract between umbilicus and bowel. Generally, tract opens into distal ileum, although may open into more proximal ileum, appendix or cecum. Also pelvic sonogram should be performed to evaluate for patent urachus.
- Cases of concommitant presentation of patent omphalomesenteric duct and urachus have been reported.
- Treatment: Surgical resection of fistula tract to the bowel with ileal reanastamosis.

References:

Khati NJ, Enquist EG, Javitt MC (1998) Imaging of the umbilicus and periumbilical region. Radiographics 18(2):413-31

Contributors:
Christian W. Cox MD, Creighton University Medical Center Radiology Resident
Paras Khandhar, Creighton University School of Medicine Student
Phillip J. Silberberg MD, Pediatric Radiologist, Omaha Children's Hospital

Crankson SJ, Ahmed GS, Palkar V (1998) Patent omphalomesenteric duct of the vermiform appendix in a neonate: congenital appendicoumbilical fistula. Pediatric Surgery International. Springer-Verlag Heidelberg, 14(13): 229-230

Lizerbram EK, Mahour GH, Gilsanz V (1997) Dual patency of the omphalomesenteric duct and urachus. Pediatric Radiology 27: 244-246

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Additional Details:

Case Number: 312303Last Updated: 11-07-2004
Anatomy: Gastrointestinal (GI)   Pathology: Congenital
Modality: GIExam Date: Access Level: Readable by all users
Keywords: omphalomesenteric duct, vitelline duct, meckel diverticulum, umbillical disorders, umbillical discharge, yolk sac remnants

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