Adult case of an omphalomesenteric cyst resected by laparoscopic-assisted surgery

Concurrent omphalomesenteric duct cyst and ileal diverticulum causing small bowel obstruction; a case report

Introduction and importance

The omphalomesenteric duct (OMD) usually involutes by the ninth gestational week. If this obliteration fails, OMD remnant will result in different pathologies mostly in the pediatrics and infrequently in adults. The most well-known OMD remnant disease is Meckel's diverticulum. Omphalomesenteric cyst is rather rare, and their combination is even more exceptional with few cases in literature.

Case presentation

We present an adolescent patient with nausea and vomiting and occasional periumbilical abdominal pain who was diagnosed with concurrent omphalomesenteric cyst and ileal diverticulum, causing internal hernia and bowel obstruction that underwent surgery.

Clinical discussion

OMD remnants mostly present in childhood with symptoms of intestinal obstruction, and rarely internal hernias for which conservative management is usually not curative, warranting surgery. Imaging presence of cystic lesion in mid abdomen in young patient with bowel obstruction should raise the suspicion for OMD remnants. Presence of OMD cyst together with Meckel's diverticulum necessitates more extensive resection, rare concurrence which is better to be prepared for in advance.

Conclusion

Preoperative radiologic workup is helpful to diagnose the obstruction and its probable cause. Presence of periumbilical cyst should raise the suspicion of OMD remnant specially in young adults with previous episodes of crampy abdominal pain and obstruction without history of abdominal surgery. Being familiar with possible concurrence of OMD cyst and Meckel's diverticulum will increase preparedness at the time of surgery.

•

The most well-known OMD remnant disease is Meckel's diverticulum.

•

Concurrent omphalomesenteric cyst and ileal diverticulum is rare.

•

Preoperative radiologic workup is helpful to diagnose the obstruction and its cause.

•

Presence of periumbilical cyst should raise the suspicion of OMD remnant.

•

Concurrent OMD cyst with diverticulum might warrant surgical intervention.

•

Familiarity with OMD cyst & diverticulum concurrence grows preparedness at surgery.

Persistent omphalomesenteric duct and urachus presenting as an umbilical hernia

Vitellointestinal duct anomalies, although one of the most frequent malformations to be found (2%-3% in population), they are most unlikely to cause symptoms. A persistent Vitellointestinal duct can induce abdominal pain, bowel obstruction, intestinal haemorrhage and umbilical sinus, fistula or hernia which commonly occurs in children. Patent vitellointestinal duct or persistent omphalomesenteric duct is a very unusual congenital anomaly which occurs in 2% of the population related to the embryonic yolk stalk. Similarly, urachal anomalies remain a rare finding, with the most common being a cyst or sinus followed by patent urachus and rarely a urachal diverticulum. Presenting symptoms include periumbilical discharge, pain and a palpable mass.Here, we report a case of an adult patient with patent vitellointestinal duct and urachus identified intraoperatively on diagnostic laparoscopy when being operated for umbilical hernia repair.

Laparoscopic treatment of intestinal obstruction due to a vitelline vascular remnant and simultaneous appendicitis: a case report

BACKGROUND

The presence of a vitelline vascular remnant is rare, and definitive preoperative diagnosis is difficult. We herein describe a case of intestinal obstruction caused by a vitelline vascular remnant with mild chronic appendicitis successfully diagnosed and treated with laparoscopic surgery.

CASE PRESENTATION

A 14-year-old male was admitted to our hospital with sudden-onset right lower abdominal pain and vomiting. A blood test on admission revealed slight leukocytosis. Computed tomography scan showed that the appendiceal wall was enhanced and thickened. Although the ileum was slightly dilated and ascites was present at the recto-vesical pouch, these were thought to be inflammatory changes secondary to appendicitis. Laparoscopic surgery was performed using three trocars. Strangulated small bowel obstruction caused by a band connecting the right medial umbilical fold to the ileal mesentery was found intraoperatively. After reduction, neither ischemic change of the small intestine nor Meckel's diverticulum was detected. The appendix was slightly inflamed, and serous ascites was present at the recto-vesical pouch; therefore, appendectomy was also performed. The patient was discharged on postoperative day 4 without complications. Pathological examination revealed that the band consisted of blood vessels, and it was diagnosed as a vitelline vascular remnant. The appendix included fecal stones and showed chronic inflammatory change histologically; the patient was thus diagnosed with chronic appendicitis.

CONCLUSIONS

Definitive preoperative diagnosis of a vitelline vascular remnant, especially with coexisting appendicitis, might be difficult. Laparoscopic surgery might be useful for patients who demonstrate unusual symptoms because it allows for simultaneous diagnosis and treatment.

Placental Teratoma, Omphalomesenteric Duct Remnant, or Intestinal Organoid (Enteroid) Differentiation: A Diagnostic Dilemma

We report an unusual case of fully developed fetal intestinal segment(s) within a nodule on the chorionic plate of the placenta of a 27-year-old female patient at 37 weeks gestation with spontaneous vaginal delivery. Gross examination of the placenta revealed a chorionic plate nodule near the insertion of the umbilical cord, which, upon microscopic evaluation, raised the differential diagnostic possibilities of placental teratoma, vitelline/omphalomesenteric duct anomaly, and intestinal organoid differentiation. We discuss the distinguishing features, morphogenesis, and clinical significance of the aforementioned entities and review the pertinent medical literature.

A rare case report of patent vitellointestinal duct causing bowel obstruction in an adult

•

Patent vitellointestinal duct is very rare congenital condition.

•

We report an unusual case of patent vitellointestinal duct causing intestinal obstruction in adult patient.

•

Awareness of this a rare cause of bowel obstruction is important for appropriate management.

Introduction

Patent vitellointestinal duct occurs in about 2% of the population which unusually leads to small intestinal obstruction associated with high morbidity and mortality. Here we are reporting an unusual case of patent vitellointestinal duct causing small intestinal obstruction in an adult patient.

Presentation of case

A 22-year-old male without any medical illness presented as an emergency with a 3 day hystory of abdominal pain, multiple episode of vomiting and abdominal distention. Distended abdomen and sign of peritonitis were found on abdominal examination. Abdominal X-rays revealed multiple small intestinal air-fluid levels. A patent vitellointestinal duct extending from distal ileum to the posterior wall of the umbilicus was found causing closed loop ileal obstruction during laparotomy. Resection of a vitellointestinal duct along with gangrenous distal ileum and cecum with ileocolostomy was performed. He was discharged on the 8 th postoperative day.

Discussion

Diagnosing and management of cause of intestinal obstruction in patients without history of abdominal surgery is very challenging. Early resuscitation and timely surgical intervention of intestinal obstruction due to a rare patent vitellointestinal duct can be life-saving measure.

Conclusion

The patent vitellointestinal duct is an uncommon entity in adults and moreover this disorder leading to intestinal obstruction is very rare. Surgeons should be aware of this infrequent cause of small bowel obstruction to allow for early diagnosis and to facilitate better patient outcomes.

Extremely rare presentation of an omphalomesenteric cyst in a 61-year-old patient

The umbilicus is remaining scar tissue from the umbilical cord in the fetus. If the omphalomesenteric duct in the umbilicus is not properly closed, an ileal-umbilical fistula, sinus formation, cysts, or, most commonly, Meckel's diverticulum can develop. The others are very rare and mostly occur in the pediatric population. We describe herein a 61-year-old female with a giant omphalomesenteric cyst presented as an asymptomatic infraumbilical mass. To our knowledge, this is the oldest patient reported and the largest cyst described in the literature. The diagnosis of a painless abdominal mass frequently suggests malignancy in older patients. But, extremely rare conditions can be detected, such as an omphalomesenteric cyst.

Serous Cystadenocarcinoma Arising in Presumed Vitelline Duct Remnant: A Case Report and Implications in the Management of Cancer of Unknown Primary

Background. Malignant neoplasms arising in Meckel's diverticulum, a vitelline duct remnant, are rare yet well-documented. Case Presentation. A 53-year-old previously healthy female presented with an enlarging midline abdominal wall mass. A computed tomography scan revealed a mass involving the linea alba, bilateral rectus abdominis, and subcutaneous fat. Extensive clinical workup failed to demonstrate other lesions, except local and paratracheal/hilar lymphadenopathy. Histopathologic examination of the resected tumor demonstrated a spectrum of serous neoplasia including serous cystadenoma, papillary serous carcinoma with numerous Psammoma bodies, and a poorly differentiated component. Immunophenotypically, the tumor cells were strongly positive for CK7, CK19, CA19.9, and MUC1 but negative for other lineage markers, findings suggestive of pancreatobiliary type differentiation. The patient died of the disease one year after the initial presentation despite chemotherapy, radiation, and surgery. Conclusion. We present a case of adenocarcinoma arising from the anterior midline abdominal wall, from presumed vitelline duct remnant, with histologic and immunophenotypic features of serous cystadenocarcinoma of pancreatobiliary origin. Though the origin from vitelline duct remnant is difficult to prove in this single case, understanding tumorigenesis of embryonic remnant origin is potentially important to improve the management of cancer of unknown primary.

Vitellointestinal Duct Anomalies in Infancy

Background: Vitellointestinal duct (VID) or omphalomesenteric duct anomalies are secondary to the persistence of the embryonic vitelline duct, which normally obliterates by weeks 5–9 of intrauterine life.

Methods: This is a retrospective analysis of a total of 16 patients of symptomatic remnants of vitellointestinal duct from period of Jan 2009 to May 2013.

Results: Male to female ratio (M:F) was 4.3:1 and mean age of presentation was 2 months and their mode of presentation was: patent VID in 9 (56.25%) patients, umbilical cyst in 2(12.25%), umbilical granuloma in 2 (12.25%), and Meckel diverticulum as content of hernia sac in obstructed umbilical hernia in 1 (6.25%) patient. Two patients with umbilical fistula had severe electrolyte disturbance and died without surgical intervention.

Conclusion: Persistent VID may have varied presentations in infancy. High output umbilical fistula and excessive bowel prolapse demand urgent surgical intervention to avoid morbidity and mortality.

A case of an omphalomesenteric duct remnant in an adult treated with laparoscopic surgery

•

An omphalomesenteric duct (OMD) remnant is a rare case in an adult.

•

A ductal structure was found between the distal ileum and the umbilicus in this case.

•

Laparoscopic surgery was performed by inserting three trocars into the left side of the abdomen.

•

A good field of view around the umbilicus and adequate working space were provided.

•

Both diagnosis and treatment were accomplished with minimally invasive laparoscopic surgery.

Introduction

The presence of an omphalomesenteric duct (OMD) remnant is a rare condition that typically affects the pediatric population. This report describes an extremely rare case of an OMD remnant that was diagnosed and resected by laparoscopic surgery in an adult.

Presentation of case

A 52-year-old man underwent a medical examination at our hospital for right lower quadrant pain. Laboratory findings showed slight leukocytosis and an elevated C-reactive protein level. A luminal structure connected to the umbilicus was detected in the right pelvic wall by abdominal computed tomography, and an OMD remnant was suspected. Laparoscopic surgery was performed by inserting three trocars into the left side of the abdomen; no trocars were inserted near the umbilicus. This procedure provided both a good field of view around the umbilicus and adequate working space. We definitively diagnosed the structure as an OMD remnant and resected it with minimal invasion. The patient was discharged on postoperative day 7 without complications. Pathologic analysis found the lumen is covered by ileum-like mucosa, and a microabscess is formed in the surrounding fat tissue.

Discussion

OMD remnants are uncommon, and their diagnosis is difficult. Most reports advocate for prompt surgical resection in symptomatic patients.

Conclusion

In the present case, definitive diagnosis and treatment were accomplished with minimally invasive laparoscopic surgery.

Omphalomesenteric duct cyst in an omphalocele: a rare association

Omphalomesenteric duct (OMD) remnants and omphalocele are not infrequently seen in paediatric patients. In most of the cases, OMD remnant in an omphalocele is a Meckel’s diverticulum; however rarely there may be other lesions. A one-day old male baby underwent surgery for omphalocele. At exploration a 10 x 12 cm cyst containing gut contents was found as the content of the omphalocele, with proximal and distal ileal loops running in continuity with it. Resection of the cyst with end to end primary gut anastomosis was done. Baby also had complex associated cardiac anomalies and died few days after surgery due to sepsis.

A rare case presentation of a symptomatic omphalomesenteric cyst in an adult, 24-year-old patient, treated with laparoscopic resection

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.

Persistent omphalomesenteric duct causing small bowel obstruction in an adult

An extremely rare case of persistent omphalomesenteric duct causing small bowel obstruction is presented. A 20-year-old female patient without medical history presented with colicky abdominal pain, vomiting, absence of passage of gas and feces, and abdominal distension of 24 h duration. Physical examination and blood tests were normal. Abdominal X-ray showed small bowel obstruction. Computed tomography of the abdomen demonstrated dilated small bowel and a band originating from the umbilicus and continuing between the small bowel loops; an omphalomesenteric duct remnant was suspected. In exploratory laparotomy, persistent omphalomesenteric duct causing small bowel obstruction was identified and resected. The patient had an uneventful recovery and was discharged on the 5^th postoperative day. Although persistent omphalomesenteric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history.