Dec 23, 2008

Vitello-intestinal Duct Remnants


Vitello-intestinal duct or omphalo-mesenteric duct connects the midgut to the yolk sac during early embryonic life. It gets obliterated and disappears during fifth to sixth week of intrauterine life.If the remnants persists then following abnormalities can occur:

1. Umbilical Polyp:

Umbilical polyp occur because of persistance of small portion of
vitello-intestinal duct epithelium at the base of umbilicus. Clinically, a polyp is seen at the base of umbilicus after the umbilical cord falls off. This differs from umbilical granuloma in the sense that it does not respond to electrical or chemical cauterization like granuloma. The polyp can be pedunculated or sessile and treatment is excision of polyp.

2. Umbilical Sinus:

When umbilical portion of
vitello-intestinal duct remains patent, an umbilical sinus forms. There is foul smelling persistent pus or mucoid discharge from umbilicus. On close examination an opening is seen in the umbilicus. Ultrasonography may reveal collection just below the umbilicus. The treatment is exploration and excision of sinus. The peritoneal cavity also opened to look for any fibrous strand connected with ileus.

3. Fibrous remnant of
vitello-intestinal duct:

vitello-intestinal duct become fibrous strand but does not disappear. This can cause mechanical intestinal obstruction at any age of the life. Exploratory laparotomy and excision of strand is all that is required.

4. Meckel's Diverticulum:
It is very well known terminology. The ileal portion of
vitello-intestinal duct remains patent and form a diverticulum, called as Meckel's diverticulum. This diverticulum characteristically arises from the antimesenteric border of the ileum within 20 cm of ileo-caecal junction. It can present with infection, bleeding or obstruction.

5. Patent
Vitello-intestinal duct:
When whole
vitello-intestinal duct remains patent cause fistulous connection between umbilicus and ileum. There is discharge of either meconium or flatus or both per umbilicus. This is tackled surgically as an emergency. The treatment is exploratory laparotomy, in toto excision of fistulous tract with the portion of the ileum attached with ileo-ileal anastomosis