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Surgical Treatment of Patent

Omphalomesenteric Duct Presenting as Faecal
Umbilical Discharge

Article in Acta chirurgica Belgica May 2004

DOI: 10.1080/00015458.2004.11679538 Source: PubMed

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Hasselt University
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Acta chir belg, 2004, 104, 211-213

Surgical Treatment of Patent Omphalomesenteric Duct Presenting as Faecal

Umbilical Discharge
G. Giacalone, J.-P. Vanrykel, F. Belva, C. Aelvoet, F. De Weer, S. Van Eldere
Department of General Surgery and Pediatrics, Imeldahospital, Bonheiden, Belgium.

Key words. Patent omphalomesenteric duct ; faecal umbilical discharge.

Abstract. A newborn infant with patent omphalomesenteric duct (POMD), who presented faecal umbilical discharge,
was treated with a semicircular periumbilical incision up to the abdominal cavity. The omphalomesenteric duct was fol-
lowed up to the junction with the small intestine and there resected. The abdominal wall was closed without resection
of the umbilicus.
There were no postoperative complications and the aesthetic result was excellent.

Case report

A 10-day old girl was referred to the surgeon for inter-

mittent faecal umbilical discharge since birth. The clini-
cal examination showed a protrusion of intestinal muco-
sa from the umbilicus with a central, non vascular lumen
from which the faecal discharge was produced (Fig. 1).
Ultrasound confirmed the existence of a tubular struc-
ture, with a fine central lumen containing air, connecting
the umbilicus with the small intestine, compatible with
patent omphalomesenteric duct.
Since the diagnosis of patent omphalomesenteric duct
was obvious, no further X-ray investigation with con-
trast was performed. The surgical correction took place
on the 11th postnatal day. A semicircular periumbilical
incision up to the abdominal cavity was made, and the
omphalomesenteric duct was followed up to the junction
with the small intestine, where a resection of the duct
was performed (Fig. 2, 3). The fistula was excised and
the umbilicus closed without resection (no umbilical
plasty). The patient had no postoperative complications
and was discharged from the hospital after 3 days. The
umbilical scar healed without necrosis (Fig. 4). Fig. 1
Appearance of the umbilicus with protrusion of intestinal
Discussion mucosa with a central non vascular lumen.

The omphalomesenteric duct (OMD) is a communica-

tion between the primitive midgut and the yolk sac.
Normally, the duct obliterates around 6 weeks of gesta-
tion. An incomplete resorption of various degrees takes
place in 2% of the population.
After birth it can persist whether as open or closed
anomaly :
Meckels diverticulum (closed)
Vitelline cyst (closed)
Vitelline ligament (closed)
Vitelline fistula (open)
The most common presentation of a closed vitelline
duct is an incidental discovery of Meckels diverticulum.
Symptomatic presentation depends upon the underlying
anomaly of the closed OMD. Rectal bleeding is associ-
ated with Meckels diverticulum, containing ectopic gas-
tric mucosa. Intestinal obstruction is caused by vitelline
212 G. Giacalone et al.

Fig. 2 Fig. 4
The patent omphalomesenteric duct is dissected from the Appearance of the umbilicus after operation
abdominal cavity : notice the junction with the small intestine.

Fig. 3
The patent omphalomesenteric duct completely dissected free

ligament of Meckels diverticulum or by omphalome-

senteric cyst. Abdominal pain is due to traction of the
vitelline ligament on the intestine. Umbilical discharge
should raise the suspicion of a patent omphalomesen-
teric duct. The open duct itself can be confused with an
umbilical granuloma. The differential diagnosis can be Fig. 5
Appearance of the umbilicus after 12 months
made using a silver nitrate stick : failure to response
should raise a suspicion of patent omphalomesenteric
duct. In that case, the distinction with a patent urachus (em-
The presence of a non vascular lumen in the umbili- bryonic remnant of communication between bladder and
cal cord should also be considered as a sign of POMD. abdominal wall) should also be made. When water-
 Surgical Treatment of Patent Omphalomesenteric Duct
soluble contrast is injected through a catheter in the non
vascular lumen, it will migrate either in the bowel
(POMD) or toward the bladder (patent urachus).
Possible complication of patent omphalomesenteric
duct includes infection of the umbilicus, periumbilical
dermatitis, bleeding from the intestinal mucosa, strangu-
lation ileus, potential for malignancy of intestinal pro-
laps leading to infarction (1-4).
Surgical techniques
In the literature, we find mainly three techniques :
1. HASEGAWA T et al. (5) used a circular incision around
the umbilicus with excision of the umbilicus and
umbilicoplasty ;
2. SHETH N. P. (6), on the other hand, used a semicircu-
lar infraumbilical incision without excision of the
umbilicus and without umbilicoplasty.
3. FLEMMING F. et al. used a circular incision around the
umbilicus also without umbilicoplasty (7).
Dissection of the patent omphalomesenteric duct
from the abdominal wall is performed by the two
authors in the same way. Laparoscopic resection of the
POMD has also been performed, but this technique does
not seem to be advantageous in children (5, 8). First
because the total length of the opening for two trocars is
bigger than the length of the periumbilical incision, and
second because not every centre has the equipment to
perform laparoscopy in new born patients.
Conclusion
For the treatment of a patent omphalomesenteric duct,
we emphasize that there is no need for a resection of the
umbilicus as proposed by HASEGAWA T et al. Simple
excision of the fistula and dissection through a perium-
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213
bilical incision give an excellent access and a perfect
cosmetic result without impairment to the vasculariza-
tion of the umbilicus in a new born infant.
In our opinion, further investigation is mandatory if
there is any doubt about the nature of the umbilical dis-
charge. If the discharge is obviously faecal there is no
need for investigative techniques, and diagnosis of
patent omphalomesenteric duct should be made on clini-
cal signs.
References
1. PERRY C. P. Recognition and treatment of persistent omphalome-
senteric ligament. A report of two cases. J Reprod Med, 1990, 35 :
636-8.
2. VANE D. W., WEST K. W., GROSFELD J. L. Vitelline duct anomalies.
Experience with 217 childhood cases. Arch Surg, 1987, 122 : 542-
7.
3. HINSON R. M., BISWAS A., MIZELLE K. M. et al. Picture of the month.
Persistent omphalomesenteric duct. Arch Pediatr Adolesc Med,
1997, 151 : 1161-2.
4. MOORE T. C. Omphalomesenteric duct malformations. Semin
Pediatr Surg, 1996, 5 : 116-23.
5. HASEGAWA T., SAKURAI T., MONTA O. et al. Transumbilical resection
and umbilical plasty for patent omphalomesenteric duct. Pediatr
Surg Int, 1998, 13 : 180-1.
6. SHETH N. P. Transumbilical resection and umbilical plasty for patent
omphalomesenteric duct. Pediatr Surg Int, 2000, 16 : 152.
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duct presenting as an umbilical discharge. Ir Med J, 2001, 94 : 182.
8. LASSEN P. M., HARRIS M. J., KEARSE W. S. Jr. et al. Laparoscopic
management of incidentally noted omphalomesenteric duct rem-
nant. J Endoruol, 1994, 8 : 49-51.
J.-P. Vanrykel
Department of General Surgery
A.Z. Imelda vzw
Imeldalaan 9
B-2820 Bonheiden, Belgium