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CASE REPORT
Year : 2016  |  Volume : 7  |  Issue : 2  |  Page : 141-143

Posttraumatic both loop ileal prolapse through patent vitello-intestinal duct in a neonate: A rare occurrence


Department of Pediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India

Date of Web Publication30-Jun-2016

Correspondence Address:
Md Hadiuzzaman Zaman
Department of Pediatric Surgery, Nil Ratan Sircar Medical College and Hospital, 138, AJC Bose Road, Kolkata - 700 014, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-9727.185017

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  Abstract 

Umbilical cord hernia (UCH) is consisting of 20% of all congenital abdominal wall defects. Vitello-intestinal duct (VID) is the communicating embryonic structure which disappears between the 5 th and 9 th weeks of intrauterine life. Here, we present an interesting case of ruptured UCH with both loop ileal prolapse through patent VID.

Keywords: Patent vitello-intestinal duct, prolapse, rupture, umbilical cord hernia


How to cite this article:
Zaman MH, Barman S, Biswas SK, Basu KS. Posttraumatic both loop ileal prolapse through patent vitello-intestinal duct in a neonate: A rare occurrence. Muller J Med Sci Res 2016;7:141-3

How to cite this URL:
Zaman MH, Barman S, Biswas SK, Basu KS. Posttraumatic both loop ileal prolapse through patent vitello-intestinal duct in a neonate: A rare occurrence. Muller J Med Sci Res [serial online] 2016 [cited 2022 Jun 27];7:141-3. Available from: https://www.mjmsr.net/text.asp?2016/7/2/141/185017


  Introduction Top


Omphalomesenteric duct/vitello-intestinal duct (VID) is an embryonic structure which communicates the vitelline duct with the small bowel. A Meckel's diverticulum (MD) is the most common congenital anomaly of the small bowel, caused by an incomplete obliteration of VID. Fecal discharge is a usual presentation in patent VID. Umbilical cord hernia (UCH) containing Meckels' is always prone for trauma which often leads to various complications such as bleeding, strangulation, prolapse, volvulus, intussusceptions, adhesions, rupture, intestinal obstruction, diverticulitis, lower gastrointestinal (GI) bleeding, and perforation peritonitis. It is always advisable to attend early surgical consultation for UCH to avoid potential morbid condition. Consciousness and awareness of similar thing should be kept in mind during or after home delivery of those trained/untrained personnel and mother.


  Case Report Top


A full term 4 days male baby had presented with bleeding from ruptured umbilical cord stump along, with prolapse of abdominal content through it. The baby was delivered at home by an untrained person. After a thorough search for history, it was found that there was a swelling of umbilical cord at its base since birth which was ruptured 3 days after birth due accidental trauma. There was no fecal discharge from umbilicus before tear. Careful examination revealed the dusky red intestinal mucosa is prolapsed (mimicking as uterus with bilateral tubes like T-shape) through the defect of umbilical cord with fecal stain at its one end [Figure 1]. After initial resuscitation, the patient was shifted to operation theater for umbilical exploration under general anesthesia. On exploration, we found that small bowel mucosa of adjacent small bowel had been prolapsed through patent VID which was the content of ruptured UCH [Figure 2]. The prolapsed bowel loops were intussuscepted proximal and distal ileal segment through patent VID. Careful reduction of prolapsed bowel and resection of adjacent ileum along with patent VID was done [Figure 3]. End-to-end ileo-ileal anastomosis was performed. The patient was discharged after 9 th postoperative day with stable condition and normal functioning bowel habit.
Figure 1: At presentation and preoperative picture showing both loop ileal prolapsed (mimicking as uterus with bilateral tubes)

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Figure 2: Intra operative picture showing ongoing reduction both loop of prolapsed ileum

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Figure 3: Resected specimen of patent vitello-intestinal duct along with adjacent unhealthy small bowel

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  Discussion Top


UCH is a well-known congenital defect which describes the failure of complete return of midgut to the peritoneal cavity by 10 th -12 th weeks of intrauterine life. In UCH, the defect is <4 cm, covered by a sac and umbilical cord is attached to its summit. [1] The peritoneum with its contents, amnion, and Wharton's jelly are the components of the sac. Newborns with congenital UCH pose a high-risk group for herniated structure injuries. Omphalomesenteric duct/VID is an embryonic structure between the yolk sac and the midgut which disappears between the 5 th and 9 th weeks of intrauterine life. [2] The spectrum of interesting anomalies may persist during obliteration of VID such as cyst, sinus, fibrous band, granuloma, and diverticulum. The most common anomaly is MD. [3] MD is occurred in 2% population and present in any age with 4-6% lifetime risk of developing a complication. [4] It is mostly asymptomatic and detected during its complications such as strangulation, prolapse, volvulus, intussusceptions, adhesions, rupture, intestinal obstruction, diverticulitis, lower GI bleeding, and perforation peritonitis. [5] Complete prolapse of patent VID in neonatal period is an uncommon anomaly and limited cases have been reported in previous literature. Only five cases of prolapse of ileal segment through patent VID have been reported in English literature. [6] Neonatal intussusception is a rare clinical entity that accounts for only 0.3% of all cases of intussusception and only 3% of all cases of neonatal intestinal obstruction. [7]

Resection of the petent VID along with segmental resection of ileum with ileo-ileal anastomosis is the treatment of choice. In emergency situation early reduction, decompression and resection-anastomosis yield good result. In our case, there was prolapse of mucosa of both limb of ileum adjacent to VID through the ruptured end of MD. This case is unique because of the rarity of presentation and not reported previously.


  Conclusion Top


Traumatic rupture of umbilical cord may happen, but careful examination should be carried out under anesthesia before reduction of prolapsed content.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Skandalakis JE, Gray SW, Ricketts R, Skandalakis LJ. The anterior body wall. In: Gray SW, Sandalakis JE, editors. Embryology for Surgeons. 2 nd ed. Baltimore: Williams & Wilkins; 1994. p. 540-93.  Back to cited text no. 1
    
2.
Sharma RK, Jain VK. Emergency surgery for Meckel′s diverticulum. World J Emerg Surg 2008;3:27.  Back to cited text no. 2
    
3.
Zea M, Chana R, Anees A, Khan S. Inverted ileal prolapse through patent vitellointestinal duct: A case report. Internet J Pediatr Neonatol 2009;10:2.  Back to cited text no. 3
    
4.
St-Vil D, Brandt ML, Panic S, Bensoussan AL, Blanchard H. Meckel′s diverticulum in children: A 20-year review. J Pediatr Surg 1991;26:1289-92.  Back to cited text no. 4
    
5.
Beyrouti MI, Ben Amar M, Beyrouti R, Abid M, Ayadi L, Abid O, et al. Complications of Meckel′s diverticulum. Report of 42 cases. Tunis Med 2009;87:253-6.  Back to cited text no. 5
    
6.
Lane V, Patel R, Daniel RD. Prolapsed urachal sinus with pyourachus in an infant. J Pediatr Surg 2013;48:e17-9.  Back to cited text no. 6
    
7.
Yoo RP, Touloukian RJ. Intussusception in the newborn: A unique clinical entity. J Pediatr Surg 1974;9:495-8.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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