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Kang A, Kim SH, Cho YH, Kim HY. Surgical perspectives of symptomatic omphalomesenteric duct remnants: Differences between infancy and beyond. World J Clin Cases 2021; 9:11228-11236. [PMID: 35071553 PMCID: PMC8717527 DOI: 10.12998/wjcc.v9.i36.11228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/29/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The clinical manifestations of omphalomesenteric duct remnant (OMDR) can vary with the age at diagnosis, from asymptomatic incidental findings to symptoms related to gastrointestinal complications. The lifelong complication rates are reported as 4%-34%, and complications are more common in patients younger than 2 years of age. The authors attempted to identify different clinical features and management for the various pediatric age groups.
AIM To find surgical perspectives for the pediatric age-related variants of OMDR and make recommendations for optimal management.
METHODS The medical records of pediatric patients diagnosed with OMDR were reviewed retrospectively. Fifteen patients diagnosed based on incidental findings during other surgeries were excluded. The patients were divided into two groups based on age: < 12 mo (infants) and > 12 mo (beyond infancy). We analyzed the demographic characteristics, clinical manifestations, diagnostic tools, surgical procedures, and clinical outcomes of the patients and compared them for the age groups. Chi-squared and Fisher's exact tests were used for nominal scales and a Mann-Whitney test was used for ratio scales.
RESULTS A total of 35 patients (7 infants, 28 children beyond infancy) were finally included. In both groups, Meckel's diverticulum (MD) was the most common type of OMDR, while umbilical lesions were more common in the infant group (P = 0.006). Hematochezia and abdominal pain were common in the beyond infancy group, while umbilical lesions were the most frequent symptoms in the infant group. Several diagnostic tools were used, but Meckel's scan was most useful in diagnosing OMDR in patients with painless rectal bleeding. Minimally invasive surgery was more commonly performed for children than for infants (P = 0.016). Single-incision laparoscopic surgery (SILS) was performed for fifteen patients who underwent laparoscopic surgery. There were only three cases of postoperative complications, and all patients survived in good condition.
CONCLUSION The clinical type of OMDR varies with age, umbilical lesions in infants, and MD beyond infancy. SILS is effective for managing children with MD regardless of age.
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Affiliation(s)
- Ayoung Kang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Soo-Hong Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Yong-Hoon Cho
- Department of Surgery, Pusan National University School of Medicine, Yangsan 50612, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Hae-Young Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
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Azhar M, Zamir N, Taqvi SR, Shaikh M. Spectrum of Omphalomesenteric Duct Related Anomalies and Their Surgical Management in Children. Cureus 2021; 13:e13898. [PMID: 33880254 PMCID: PMC8046167 DOI: 10.7759/cureus.13898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of this study was to evaluate the clinical presentation and surgical management of omphalomesenteric duct (OMD) remnants in children. Material and methods A descriptive retrospective study was conducted at the Department of Paediatric Surgery of the National Institute of Child Health, Karachi, Pakistan, from April 2017 to January 2020. Children below 12 years of age with various OMD remnants were included in the study. Data regarding age of presentation, type of anomaly, and management collected during this period were reviewed and analyzed using SPSS Version 22 (IBM Corp., Armonk, NY, USA). Results A total of 86 patients, 47 males and 39 females, were managed during the study period. Intestinal obstruction was observed in 44 (51.16%) cases followed by OMD-related umbilical anomalies in 14 (16.27%) cases, acute abdominal pain in 12 (13.95%), rectal bleeding in 3 (3.48%) patients. In 13 (15.16%) cases, Meckel’s diverticulum was discovered incidentally. In 21 cases, wedge resection and ileal repair was performed, whereas 32 required segmental resection and end-to-end anastomosis, and in 32 cases ileostomy was created after resection. Histopathology showed the presence of ectopic mucosa in five cases. Conclusion Patients with OMD remnants had various presentations. The surgical procedure has to be tailored according to the clinical and surgical findings.
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Affiliation(s)
- Muhammad Azhar
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK.,Paediatric Surgery, Jinnah Sindh Medical University, Karachi, PAK
| | - Naima Zamir
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK
| | - Syed R Taqvi
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK
| | - Mishraz Shaikh
- Paediatric Surgery, National Institute of Child Health, Karachi, PAK
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Ghritlaharey RK. Management of Patent Vitellointestinal Duct in Infants. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2021. [DOI: 10.1055/s-0041-1722836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Objectives This study was undertaken to investigate and review the clinical presentation, surgical procedures executed, and the final outcome of infants managed for the patent vitellointestinal duct.
Materials and Methods This is a single-institution, retrospective study and included infants who were operated for the patent vitellointestinal duct. This study was conducted at author’s Department of Paediatric Surgery during the last 20 years; from January 1, 2000 to December 31, 2019.
Results A total of 24 infants were operated for the patent vitellointestinal duct during the study period and comprised 20 (83.3%) boys and 4 (16.6%) girls. The age of infants ranged from 7 days to 10 months, with a mean of 88.41 ± 64.9 days. Twenty-three (95.8%) infants were operated within 6 months of the age, 17 (70.8%) of them were operated within 3 months of the age. Only one (4.1%) infant was operated at the age of 10 months. Among 24 infants, 13 (54.1%) were presented with features suggestive of acute intestinal obstruction and remaining 11 (45.8%) were presented with fecal discharges through the umbilicus without intestinal obstruction. Among 13 infants who presented with acute intestinal obstruction, 12 had prolapsed bowel and 6 of them also had gangrenous bowel. Operative procedures were executed (n = 24) in the following order of frequency: (1) resection of patent vitellointestinal duct, wide wedge resection of ileum,and ileal repair (n = 13, 54.1%); (2) resection of patent vitellointestinal duct, small segment of ileum, and ileoileal anastomosis (n = 9, 37.5%); and (3) resection of patent vitellointestinal duct, segment of ileum, and an ileostomy (n = 2, 8.33%). Postoperatively, two (8.3%) infants developed anastomotic leak and peritonitis one each, later on, both of them died.
Conclusion Patent vitellointestinal duct not only present with fecal discharges through the umbilicus but half of the infants presented with prolapsed bowel and with features of acute small bowel obstruction. Delay in seeking treatment for such cases was associated with considerable morbidity and mortality and therefore the patent vitellointestinal duct should be excised at the earliest.
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Affiliation(s)
- Rajendra K. Ghritlaharey
- Department of Paediatric Surgery, Gandhi Medical College and Associated Kamla Nehru and Hamidia Hospital, Bhopal, Madhya Pradesh, India
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Tatekawa Y. Omphalomesenteric duct resection using an intraumbilical round incision or a transumbilical vertical incision: report of two cases. J Surg Case Rep 2020; 2020:rjaa428. [PMID: 33149889 PMCID: PMC7593119 DOI: 10.1093/jscr/rjaa428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022] Open
Abstract
We report our experience with two patients who underwent omphalomesenteric duct resection: one for a patent omphalomesenteric duct and the other for a Meckel diverticulum connected to the umbilicus by a fibrous cord. We used an intraumbilical round incision and a transumbilical vertical incision, respectively. The first patient was a neonate with a patent omphalomesenteric duct who appeared to have a small stoma after ligature of the umbilical cord. Contrast media, injected through a catheter inserted into the stoma, entered the lumen of the small bowel. The second patient was an infant with a Meckel diverticulum connected to the umbilicus by a fibrous cord. After bloody stool was noted, nuclear imaging using 99m technetium pertechnetate revealed a small, round area of intense tracer activity in the midabdomen, suggesting the presence of ectopic gastric mucosa. Using either an intraumbilical or a transumbilical incision is safe and provides good cosmesis.
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Affiliation(s)
- Yukihiro Tatekawa
- Correspondence address. Department of Pediatric Surgery, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku-shi, Nagano, 385-0051, Japan. Tel: +81-267-62-8181; Fax: +81-267-88-7354; E-mail:
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Seye C, Mbaye PA, Ndoye NA, Diouf C, Fall M, Sagna A, Ndour O, Ngom G. [Omphalomesenteric fistulas; epidemiological diagnostic and therapeutic features: study of four cases in the Department of Pediatric Surgery at the Aristide Le Dantec University Hospital in Dakar]. Pan Afr Med J 2020; 37:165. [PMID: 33425198 PMCID: PMC7757306 DOI: 10.11604/pamj.2020.37.165.19187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/19/2019] [Indexed: 11/27/2022] Open
Abstract
Le but de cette étude était de déterminer les aspects épidémiologiques, diagnostiques et thérapeutiques de la fistule omphalo-mésentérique (FOM). Nous avons colligé quatre observations sur une période de 10 ans allant de janvier 2004 à décembre 2013. Les paramètres étudiés étaient la fréquence, l'âge, le sexe, les signes cliniques et radiologiques, les aspects thérapeutiques et évolutifs. La fréquence était de 0,4 cas par an. Les patients étaient âgés respectivement de 11 jours, 40 jours, 45 jours et 3 ans avec trois filles et un garçon. L´examen clinique avait retrouvé un écoulement de liquide intestinal à travers l´ombilic et un bourgeon ombilical cathétérisable dans tous les cas. Le bourgeon était prolabé chez le patient âgé de 45 jours. La fistulographie réalisée dans deux cas a permis de confirmer le diagnostic en montrant une communication entre la fistule et le grêle. Le bilan malformatif a révélé une cardiopathie congénitale cyanogène avec une communication inter ventriculaire chez l´enfant âgé de 45 jours, une malformation ano-rectale (MAR) de type cloacal associée à une fistule de l´ouraque chez le nouveau-né âgé de 11 jours. Tous les patients ont bénéficié d´un traitement chirurgical. La voie péri-ombilicale semi-circulaire était utilisée en l´absence de malformations abdomino-pelviennes associées. La communication de la fistule avec l´iléon était retrouvée dans la majorité des cas. Une résection intestinale avec anastomose termino-terminale était réalisée dans trois cas; la résection cunéiforme était faite dans un cas complet d´une exérèse complète du trajet fistuleux ouraquien et une suture vésicale, avec une colostomie de dérivation chez le nouveau-né présentant une fistule de l´ouraque et une MAR de type cloacal. Les suites opératoires étaient marquées par des crises convulsives non fébriles chez le 1er enfant ayant évolué favorablement, une suppuration pariétale superficielle suivie de décès par décompensation cardiaque chez le 3e cas. La fistule omphalo-mésentérique est une pathologie rare. Son diagnostic repose sur la clinique complétée par la fistulographie. Son traitement chirurgical par voie péri-ombilicale semi-circulaire donne de bons résultats. Cependant, le bilan malformatif est nécessaire.
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Affiliation(s)
- Cheikh Seye
- Université Alioune Diop de Bambey, Diourbel, Sénégal
| | | | - Ndeye Aby Ndoye
- Université Assane Seck de Ziguinchor, Ziguinchor 27000, Sénégal
| | - Cheikh Diouf
- Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Mbaye Fall
- Université Assane Seck de Ziguinchor, Ziguinchor 27000, Sénégal
| | - Aloïse Sagna
- Université Assane Seck de Ziguinchor, Ziguinchor 27000, Sénégal
| | - Oumar Ndour
- Université Assane Seck de Ziguinchor, Ziguinchor 27000, Sénégal
| | - Gabriel Ngom
- Université Assane Seck de Ziguinchor, Ziguinchor 27000, Sénégal
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6
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Surgical abdominal exploration in children with umbilical ectopic gastrointestinal tissue. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Umbilical lesions are rare, but it is important to cautiously inspect and investigate every umbilical nodule or growth to rule out the possibility of embryological remnant and associated congenital anomaly in infants and children and hidden malignancy in adults. Certain umbilical anomalies can be expected in association with certain syndromes (i.e., known unknowns), and at times can be identified during prenatal screening, while others are simply unforeseeable conditions that may arise unexpectedly (i.e., unknown unknowns). Umbilical lesions can be diagnosed on careful clinical and histopathological evaluation. Benign tumours are much more common than metastatic deposits. Certain lesions such as umbilical granuloma can be managed conservatively, while exomphalos and complicated umbilical hernia require urgent surgical intervention. This review article will help to elucidate the spectrum of umbilical lesions, with special emphasis on the importance of proper evaluation of often neglected, but clinically important entities.
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Affiliation(s)
- Aditi Das
- Pathology, Pandit Jawaharlal Nehru Memorial Government Medical College, Raipur, IND
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8
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Oliveira CS, Pessanha I, Santos L, Machado M, Zenha R. Visual Diagnosis: 21-day-old Boy with an Umbilical Drainage. Pediatr Rev 2019; 40:e25-e27. [PMID: 31263050 DOI: 10.1542/pir.2017-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Inês Pessanha
- Department of Pediatric Surgery, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Liliana Santos
- Department of Pediatric Surgery, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Marta Machado
- Department of Pediatrics, Baixo Vouga Medical Center, Aveiro, Portugal
| | - Raquel Zenha
- Department of Pediatrics, Baixo Vouga Medical Center, Aveiro, Portugal
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9
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Handayani H, Zega Y, Ziliwu T, Yaputra F, Minori N. Inverted Proximal Ileal Loop Prolapse with Ileal Rupture through a Patent Omphalomesenteric Duct: A Rare Case. Open Access Maced J Med Sci 2019; 7:797-800. [PMID: 30962843 PMCID: PMC6447338 DOI: 10.3889/oamjms.2019.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/13/2019] [Accepted: 01/20/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Prolapse of the small intestine through the umbilicus is indeed a rare presentation and is the most significant complication of the patent omphalomesenteric duct which requires pediatric surgical emergency due to its significant increase of mortality. To date, it is less than twenty cases of this presentation have been reported in medical literature. We are reporting a case of the same in an infant presenting with it on 1st week after he was delivered, but was followed by ileal rupture as well. CASE PRESENTATION We present a case of a patent omphalomesenteric duct with ileal prolapse and ileal rupture as its complication. It is a case of a 1-year-old infant with a history of unusual bleed-on-touch mass emerging from the anterior abdominal wall with absent umbilicus. Once his condition is stabilised, he underwent a reduction of the prolapsed bowel along with complete excision of the omphalomesenteric duct and restoration of the ileal continuity. Post-operatively he regained normal bowel function and resumed breastfeeding 5 days after surgery. CONCLUSION This case is an important addition to the literature about patent omphalomesenteric duct with complications of inverted proximal ileal loop prolapse and ileal rupture.
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Affiliation(s)
- Handayani Handayani
- Department of Pediatrics, Gunungsitoli General Hospital, Nias, North Sumatera, Indonesia
| | - Yamoguna Zega
- Department of Surgery, Gunungsitoli General Hospital, Nias, North Sumatera, Indonesia
| | - Tati Ziliwu
- Department of Pediatrics, Gunungsitoli General Hospital, Nias, North Sumatera, Indonesia
| | - Faldi Yaputra
- Department of Neurology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Nora Minori
- Department of Surgery, Faculty of Medicine, Sumatra Utara University, Adam Malik Hospital, Medan, Indonesia
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10
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Cutaneous presentations of omphalomesenteric duct remnant: A systematic review of the literature. J Am Acad Dermatol 2019; 81:1120-1126. [PMID: 30797849 DOI: 10.1016/j.jaad.2019.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Disorders of the umbilicus are commonly seen in infancy, including hernias, infections, anomalies, granulomas, and malignancies. Meticulous inspection of the umbilicus at birth might reveal a persisting embryonic remnant, such as an omphalomesenteric duct (OMD), manifested by a variety of cutaneous signs, such as an umbilical mass, granulation tissue, or discharge. OBJECTIVE To systematically review the available data regarding the presence and management of OMD remnant with cutaneous involvement to suggest a practical approach for diagnosis and treatment. METHODS A systematic review of the literature evaluating OMD anomalies presenting with cutaneous symptoms was performed. In addition, an index case of an 11-month-old patient is presented. RESULTS We included 59 publications reporting 536 cases; 97% of the patients whose age was noted were infants (mean age 11 months). In 7.5% of the cases, diagnosis was established only after treatment failure. In 6.4% of patients, nonlethal complications were reported, and in 10.3%, the outcome was death, partly due to delayed diagnosis or mismanagement. LIMITATIONS Limited quality of the collected data, reporting bias. CONCLUSION OMD is relatively rare; however, the clinician must consider this remnant while examining patients with umbilical abnormalities because mismanagement could cause severe morbidity and mortality.
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Parvanescu A, Bruzzi M, Voron T, Tilly C, Zinzindohoué F, Chevallier JM, Gucci M, Wind P, Berger A, Douard R. Complicated Meckel's diverticulum: Presentation modes in adults. Medicine (Baltimore) 2018; 97:e12457. [PMID: 30235734 PMCID: PMC6160168 DOI: 10.1097/md.0000000000012457] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Complicated Meckel's diverticulum represents a common etiology of acute abdomen in children. However, this condition is less frequent in adults. We reviewed the records of adult patients who underwent the surgical removal of complicated Meckel's diverticulum between 2001 and 2017 at 2 tertiary French medical centers. We then analyzed the clinical characteristics, mode of presentation, and management for all patients.The Meckel's diverticulum was resected in 37 patients (24 males and 13 females). The mean patient age was 46.1 ± 21.4 years. The most common clinical presentations of complicated Meckel's diverticulum were diverticulitis (35.1%, n = 13), small-bowel obstruction (35.1%, n = 13), and gastrointestinal bleeding (29.8%, n = 11) (anemia, n = 1; hematochezia, n = 10). Age distribution was significantly different (P = .02) according to the 3 Meckel's diverticulum complications: patients with diverticulitis (P = .02) were statistically more frequently over 40 (P = .05), significantly older than patients with gastrointestinal bleeding who were more frequently <40 (P = .05). There was a preoperative diagnosis available for 15 of the 37 patients (40%). An exploratory laparoscopy was necessary to determine the cause of disease for the other 22 patients (60%). An intestinal resection was performed in 33 patients (89%) and diverticulectomy was performed in 4 patients (11%). There was heterotopic tissue found in only 6 patients (16%). Postoperative complications were as follows: 1 death by cardiac failure in a 92-year-old patient and 2 patients with postoperative wound infections. The follow-up time was 3 to 12 months.The correct diagnosis of complicated Meckel's diverticulum in adults is difficult due to the lack of specific clinical presentation. As a result, exploratory laparoscopy appears to play a central role in cases of acute abdomen with uncertain diagnosis.
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Affiliation(s)
- Alina Parvanescu
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Matthieu Bruzzi
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
| | - Thibault Voron
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Camille Tilly
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Franck Zinzindohoué
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Jean-Marc Chevallier
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
| | - Marco Gucci
- Digestive Surgery Unit, Avicenne University AP-HP Hospital
- UFR SMBH, Paris-Nord, Faculty of Medicine, Bobigny, France
| | - Philippe Wind
- Digestive Surgery Unit, Avicenne University AP-HP Hospital
- UFR SMBH, Paris-Nord, Faculty of Medicine, Bobigny, France
| | - Anne Berger
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
| | - Richard Douard
- Digestive Surgery Unit, European Georges Pompidou University AP-HP Hospital
- Paris Descartes Faculty of Medicine
- ANCRE, EA 4465, Paris Descartes University, Paris
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Hansen CC, Søreide K. Systematic review of epidemiology, presentation, and management of Meckel's diverticulum in the 21st century. Medicine (Baltimore) 2018; 97:e12154. [PMID: 30170459 PMCID: PMC6392637 DOI: 10.1097/md.0000000000012154] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The contemporary demographics and prevalence of Meckel's diverticulum, clinical presentation and management is not well described. Thus, this article aims to review the recent literature concerning Meckel's diverticulum. METHODS A systematic PubMed/Medline database search using the terms "Meckel" and "Meckel's" combined with "diverticulum." English language articles published from January 1, 2000 to July 31, 2017 were considered. Studies reporting on the epidemiology of Meckel's diverticulum were included. RESULTS Of 857 articles meeting the initial search criteria, 92 articles were selected. Only 4 studies were prospective. The prevalence is reported between 0.3% and 2.9% in the general population. Meckels' diverticulum is located 7 to 200 cm proximal to the ileocecal valve (mean 52.4 cm), it is 0.4 to 11.0 cm long (mean 3.05 cm), 0.3 to 7.0 cm in diameter (mean 1.58 cm), and presents with symptoms in 4% to 9% of patients. The male-to-female (M:F 1.5-4:1) gender distribution is reported up to 4 times more frequent in men. Symptomatic patients are usually young. Of the pediatric symptomatic patients, 46.7% have obstruction, 25.3% have hemorrhage, and 19.5% have inflammation as presenting symptom. Corresponding values for adults are 35.6%, 27.3%, and 29.4%. Ectopic gastric tissue is present in 24.2% to 71.0% of symptomatic Meckel's diverticulum, is associated with hemorrhage and is the most common form of ectopic tissue, followed by ectopic pancreatic tissue present in 0% to 12.0%. CONCLUSION The epidemiological patterns and clinical presentation appears stable in the 21st century. A symptomatic Meckel's diverticulum is managed by resection. The issue of prophylactic in incidental Meckel's diverticulum resection remains controversial.
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Affiliation(s)
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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13
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Abstract
The umbilical cord, a vital conduit between the placenta and the fetus, loses much of its significance after birth. However, newborns can often present with various abnormalities of the umbilicus, such as benign granulomas or more serious lesions due to persistent remnants, many of which can change the normal course of cord separation and may be associated with significant morbidities if left unrecognized and uncorrected. Although not uncommon, sanguineous drainage from the umbilical stump can be quite alarming to new parents. Parental counseling regarding normal umbilical cord changes, as well as abnormal findings, such as discharge and skin changes, are important for the recognition and timely treatment of potentially significant umbilical cord disorders.
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Affiliation(s)
- Hemananda Muniraman
- Division of Neonatal-Perinatal Medicine, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Tara Sardesai
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Smeeta Sardesai
- Division of Neonatal-Perinatal Medicine, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
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14
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Stratmann R, Meyer T. [Persistent abdominal complaints after laparoscopic appendectomy]. Chirurg 2017; 89:149-151. [PMID: 29022082 DOI: 10.1007/s00104-017-0532-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R Stratmann
- Abteilungfür Kinderchirurgie, Klinik und Poliklinik für Allgemein- und Viszeralchirurgie, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Klinikum der Bayerischen Julius-Maximilians-Universität, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - T Meyer
- Abteilungfür Kinderchirurgie, Klinik und Poliklinik für Allgemein- und Viszeralchirurgie, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Klinikum der Bayerischen Julius-Maximilians-Universität, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
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Abstract
INTRODUCTION Neurofibromatosis type 1 (NF1) is the most commonly inherited autosomal dominant disorder in humans. NF1 patients have increased risk for gastrointestinal stromal tumors (GISTs). A Meckel's diverticulum (MD) represents a persistent embryonic omphalomesenteric duct characterized as a true diverticulum located near the ileocecal valve. We report a unique clinical case whereby a patient with NF1 developed a GIST within a MD. CASE An adolescent male with NF1 presented with persistent lower abdominal pain. Clinical evaluation demonstrated a large pelvic mass. In the operating room, the mass was noted to emerge from a MD. Final pathology demonstrated a GIST with negative margins and CD117 positivity. DISCUSSION Patients with NF1 are at increased risk for mesenchymal tumors including malignant peripheral nerve sheath tumors. GISTs are the most important and frequent non-neurological malignancy in NF1 and develop in ∼7% of NF1 patients. GISTs tend to be multifocal in NF1; however, they rarely occur within a Meckel's diverticula. CONCLUSIONS Our case represents a rare case of a patient with NF1 who developed a symptomatic GIST within a MD. We recommend utilizing laparoscopy to determine resectability and clarify the diagnosis in this unique patient population who are at risk for multiple neoplasms.
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Hegazy AA. Anatomy and embryology of umbilicus in newborns: a review and clinical correlations. Front Med 2016; 10:271-7. [PMID: 27473223 DOI: 10.1007/s11684-016-0457-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/12/2016] [Indexed: 02/07/2023]
Abstract
Umbilicus is considered a mirror of the abdomen in newborns. Despite its importance, the umbilicus has been stated in literature and textbooks as discrete subjects with many body systems, such as the urinary, digestive, and cardiovascular ones. This article aimed to address the basic knowledge of the umbilicus in relation to clinical disorders under one integrated topic to aid physicians and surgeons in assessing newborns and infants. The umbilicus appears as early as the fourth week of fetal life when the folding of the embryonic plate occurs. The umbilicus appears initially as a primitive umbilical ring on the ventral aspect of the body. The primitive umbilicus contains the connecting stalk, umbilical vessels, vitelline duct and vessels, allantois, and loop of the intestine. Changes occur to form the definitive cord, which contains three umbilical vessels, namely, "one vein and two arteries," embedded in Wharton's jelly. After birth, the umbilical vessels inside the body obliterate and gradually form ligaments. Congenital disorders at the umbilicus include herniation, bleeding, and discharge of mucous, urine, or feces. Some of these disorders necessitate emergent surgical interference, whereas others may be managed conservatively. The umbilicus has many embryological remnants. Thus, the umbilicus is prone to various clinical disorders. Detecting these disorders as early as possible is essential to prevent or minimize possible complications.
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Affiliation(s)
- Abdelmonem A Hegazy
- Department of Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
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17
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Abstract
Obturator hernia is an uncommon condition. It carries the highest mortality amongst abdominal wall hernias, usually presenting in elderly, multiparous and thin ladies. Meckel diverticulum is a rare cause of intestinal obstruction and its existence in an obturator hernia is extremely rare; our literature search revealed only two reported cases. We report the case of a 70-year-old woman who presented with signs and symptoms of intestinal obstruction and peritonitis. An exploratory laparotomy led to diagnosis of a strangulated obturator hernia. The sac contents included a Meckel diverticulum with a perforation at its base and a loop of the ileum. The ischemic ileal segment including the Meckel diverticulum was resected and a loop ileostomy was created.
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Affiliation(s)
| | - Zain Ul Abideen
- Dr. Zain Ul Abideen, Department of Medicine,, Rawalpindi Medical College,, Holy Family Hospital,, Punjab 44000, Pakistan, 923335565947,
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Park JS, Lim CW, Park T, Cho JM, Seo JH, Youn HS. Suppurative meckel diiverticulum in a 3-year-old girl presenting with periumbilical cellulitis. Pediatr Gastroenterol Hepatol Nutr 2015; 18:66-70. [PMID: 25866736 PMCID: PMC4392003 DOI: 10.5223/pghn.2015.18.1.66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/02/2014] [Accepted: 10/09/2014] [Indexed: 12/30/2022] Open
Abstract
Meckel diverticulum (MD) is one of the most common congenital gastrointestinal anomalies and occurs in 1.2-2% of the general population. MD usually presents with massive painless rectal bleeding, intestinal obstruction or inflammation in children and adults. Suppurative Meckel diverticulitis is uncommon in children. An experience is described of a 3-year-old girl with suppurative inflammation in a tip of MD. She complained of acute colicky abdominal pain, vomiting and periumbilical erythema. Laparoscopic surgery found a relatively long MD with necrotic and fluid-filled cystic end, which was attatched to abdominal wall caused by inflammation. Herein, we report an interesting and unusual case of a suppurative Meckel diverticulitis presenting as periumbilical cellulitis in a child. Because of its varied presentations, MD might always be considered as one of the differential diagonosis.
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Affiliation(s)
- Ji Sook Park
- Department of Pediatrics, Institute of Health Science, Gyeongsang National University Hospital, Jinju, Korea
| | - Chun Woo Lim
- Department of Pediatrics, Institute of Health Science, Gyeongsang National University Hospital, Jinju, Korea
| | - Taejin Park
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jae-Min Cho
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji-Hyun Seo
- Department of Pediatrics, Institute of Health Science, Gyeongsang National University Hospital, Jinju, Korea
| | - Hee-Shang Youn
- Department of Pediatrics, Institute of Health Science, Gyeongsang National University Hospital, Jinju, Korea
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19
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Bagade S, Khanna G. Imaging of omphalomesenteric duct remnants and related pathologies in children. Curr Probl Diagn Radiol 2015; 44:246-55. [PMID: 25823549 DOI: 10.1067/j.cpradiol.2014.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 01/01/2023]
Abstract
The omphalomesenteric duct (OMD) or the vitelline duct (VD) is the embryologic communication between the yolk sac and the primitive midgut. OMD or VD anomalies are a group of defects resulting from failure of involution of the OMD. Meckel diverticulum is the most common anomaly that results from failure of resorption of the OMD. Other less common anomalies seen in children include OMD fibrous band, fistula, sinus tract, cyst, and umbilical polyps. These OMD remnants can have variable clinical manifestations such as umbilical discharge, small bowel obstruction, gastrointestinal tract bleeding, or acute abdomen. This pictorial essay reviews the clinical presentation and imaging findings of the common and not so common complications of OMD remnants in the pediatric population.
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Affiliation(s)
- Swapnil Bagade
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO.
| | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO
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20
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Huang CC, Lai MW, Hwang FM, Yeh YC, Chen SY, Kong MS, Lai JY, Chen JC, Ming YC. Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases. Pediatr Neonatol 2014; 55:369-75. [PMID: 24685339 DOI: 10.1016/j.pedneo.2013.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/13/2013] [Accepted: 12/09/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Our objective was to analyze demographics and characteristics of Meckel's diverticulum with different manifestations in pediatric patients. METHODS This is a retrospective study in children with symptomatic Meckel's diverticulum who underwent resection between September 1998 and October 2010. The diagnosis was confirmed by surgery and pathology. Demographic characteristics, manifestations, Meckel's scan results, surgical and histological findings were analyzed. RESULTS One hundred symptomatic Meckel's diverticula were identified in 74 boys and 26 girls aged from one day to 18 years old over 13 years. Depending on whether or not obstruction occurred, the patients were classified into two categories. Each category was further subdivided into two diagnostic groups: 17 intussusception and 24 non-intussusception bowel obstruction in the obstructive category and 44 gastrointestinal bleeding and 15 diverticulitis and/or perforation in the non-obstructive category. The sex discrepancy was higher in the non-obstructive category than in the obstructive category (male-to-female, 4.36 vs. 1.73, p < 0.05). Forty-one of 44 patients with gastrointestinal bleeding underwent a Meckel's scan with a high positive rate (92.7%). The ectopic tissues were identified in 73 patients and included 61 gastric type, two pancreatic type and 10 mixed type. Ectopic tissues were more prevalent in non-obstructive category (p < 0.05) with ectopic gastric tissue even more pronounced (p < 0.01). Ectopic pancreatic tissue was significantly more prevalent in intussusception (p < 0.01). Laparoscopic surgery was performed more frequently in Meckel's diverticulum with non-obstructive symptoms (p < 0.001). CONCLUSION Diverse presentations in pediatric Meckel's diverticulum are affected by different ectopic tissue types and male sex. Laparoscopic surgery is widely used for children with non-obstructive symptoms.
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Affiliation(s)
- Chen-Chuan Huang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Fang-Ming Hwang
- Department of Education, National Chiayi University, Chiayi, Taiwan
| | - Yu-Chen Yeh
- Institute of Education, National Chiao Tung University, Hsinchu, Taiwan
| | - Shih-Yen Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Man-Shan Kong
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jeng-Chang Chen
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Ching Ming
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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21
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Abstract
The incidence of congenital urachal, bladder, and cloacal anomalies is low. Urachal remnants are the result of failure or delay in obliteration of the allantois. Exstrophy of the bladder or cloaca can be diagnosed on prenatal ultrasonography and represent a deviation from the normal embryologic sequence. Persistent cloaca is an anomaly occurring in girls, in which a common cavity exists into which the intestinal, urinary, and reproductive tracts all open. It is also often diagnosed on prenatal imaging.
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Affiliation(s)
- Angela M Arlen
- Children's Healthcare of Atlanta, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, USA.
| | - Edwin A Smith
- Children's Healthcare of Atlanta, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, USA; Georgia Urology, PA, 5445 Meridian Mark Road, Suite 420, Atlanta, GA 30342, USA
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Annaberdyev S, Capizzani T, Plesec T, Moorman M. A rare case presentation of a symptomatic omphalomesenteric cyst in an adult, 24-year-old patient, treated with laparoscopic resection. J Gastrointest Surg 2013; 17:1503-6. [PMID: 23609141 DOI: 10.1007/s11605-013-2207-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/10/2013] [Indexed: 01/31/2023]
Abstract
A persistent omphalomesenteric duct remnant is a rare finding, which typically presents in the pediatric population. Most commonly, it is encountered in the form of a Meckel's diverticulum. In rare instances, omphalomesenteric cysts have been reported in the pediatric population. We present a case of a symptomatic omphalomesenteric cyst in an adult male and our management of this entity.
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Affiliation(s)
- Shohrat Annaberdyev
- Cleveland Clinic Department of General Surgery, Digestive Disease Institute, Cleveland, OH 44195, USA.
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23
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Kondrich J, Woo T, Ginsburg HB, Levine DA. Evisceration of small bowel after cauterization of an umbilical mass. Pediatrics 2012; 130:e1708-10. [PMID: 23166332 DOI: 10.1542/peds.2012-0623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The omphalomesenteric duct (OMD), a temporary structure essential to fetal development, normally involutes completely by week 8 or 9 of gestation. On occasion, the OMD persists, the clinical presentations of which vary widely. We describe a case of a 6-week-old male with a patent OMD remnant that was initially treated as an umbilical granuloma, which then potentially allowed for prolapse of the small bowel through the umbilical ring. The patient required resection of the incarcerated bowel but had an otherwise uneventful and complete recovery.
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Affiliation(s)
- Janienne Kondrich
- Division of Pediatric Emergency Medicine, New York University Langone Medical Center, New York, NY 10016, USA
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24
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Abstract
PURPOSE OF REVIEW Evaluation of the child with acute abdominal pain is challenging because of the wide range of potential diagnoses. Presenting symptoms, clinical examination, and laboratory findings can guide selection of diagnostic imaging. RECENT FINDINGS Intussusception and intestinal malrotation are potentially serious causes of intestinal obstruction, which are best evaluated by ultrasound and upper gastrointestinal series, respectively. Ultrasound has diagnostic importance in the evaluation of multiple diseases, including appendicitis, by potentially decreasing the need for inpatient observation, cholecystitis and complications of gall stones such as pancreatitis, and ovarian diseases. Pelvic inflammatory disease should be considered in evaluation of a teenage girl with lower abdominal pain. Less common causes of acute abdominal pain include ingested foreign bodies, infected congenital anomalies, and perforated peptic ulcer disease. SUMMARY Presenting symptoms and physical examination findings can narrow the number of potential diagnoses in pediatric acute abdominal pain and thereby guide diagnostic imaging selection. Abdominal/pelvic ultrasound, rather than computed tomography scan, is the preferred modality for initial evaluation of many potential causes of pediatric abdominal pain.
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Persistent umbilical discharge from an omphalomesenteric duct cyst containing gastric mucosa. Case Rep Pediatr 2012; 2012:482185. [PMID: 22693676 PMCID: PMC3368171 DOI: 10.1155/2012/482185] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 03/27/2012] [Indexed: 01/07/2023] Open
Abstract
Umbilical discharge in infancy is often attributed to infection or an umbilical granuloma. It is important to investigate if such a discharge is due to an underlying congenital abnormality because corrective surgical intervention may then be required. We present the first case of an infant with a persistent umbilical discharge from an omphalomesenteric duct cyst. The discharge was associated with periumbilical dermatitis. The dermatitis was most likely due to irritation of the skin by gastric acid produced by the ectopic gastric mucosa contained in the omphalomesenteric duct cyst. Both discharge and dermatitis resolved after surgical removal of the cyst.
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