Omphalocele and patent omphalomesenteric duct: A case report

Abstract

Introduction

The omphalomesenteric duct (OMD) is an embryonic structure that connects the yolk sac to the midgut. Under normal circumstances, it closes and self absorbes before birth. When the OMD does not obliterate, it remains patent after birth. Patent OMD are hardly ever associated with other congenital anomalies.

Case presentation

A 1-day-old term male neonate was referred to our hospital with a postnatal diagnosis of omphalocele minor. The omphalocele had not been seen on any of the prenatal ultrasounds. He was born by vaginal delivery with a weight of 2700 g. In addition to the omphalocele, the physical exam revealed a mucosal opening on the membrane of the omphalocele. A patent OMD was suspected, since meconium was draining through the mucosal opening. Abdominopelvic ultrasound showed bowel loops within the omphalocele sac. All other intra-abdominal organs appeared normal. Echocardiography revealed tricuspid atresia and a large ventricular septal defect. On the second day of life the patient was taken to the operating room for an exploratory laparotomy. The abdomen was accessed through an incision on the junction between the skin and the membrane of the omphalocele. The bowel was detached bluntly from the inner surface of the omphalocele membrane. While the bowel was exposed, a Meckel's diverticulum was found close to the ileo-cecal valve. The tip of the Meckel's diverticulum was open and fused wo the membrane of the omphalocele. We resected the segment of the small bowel that contained the Meckel's diverticulum and did an end-to-end anastomosis. After that, the omphalocele defect was closed. The patient died on the second postoperative day from his congenital heart disease.

Conclusion

Patent OMD should be suspected in patients with omphalocele who have a mucosal opening on the omphalocele membrane that drains meconium.