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Journal of Indian Association of Pediatric Surgeons
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Table of Contents   
LETTERS TO THE EDITOR
Year : 2021  |  Volume : 26  |  Issue : 5  |  Page : 363-364
 

Double intussuscepted patent vitellointestinal duct


Department of Paediatric Surgery, Topiwala National Medical College and B.Y.L Nair Ch. Hospital, Mumbai, Maharashtra, India

Date of Submission31-Mar-2021
Date of Decision21-Apr-2021
Date of Acceptance15-Jun-2021
Date of Web Publication16-Sep-2021

Correspondence Address:
Dr. Neha Sisodiya Shenoy
Department of Paediatric Surgery, Topiwala National Medical College and B.Y.L Nair Ch. Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_9_21

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How to cite this article:
Basu S, Makan A, Tulsian A, Joseph V, Gandhi S, Shenoy NS, Shah H. Double intussuscepted patent vitellointestinal duct. J Indian Assoc Pediatr Surg 2021;26:363-4

How to cite this URL:
Basu S, Makan A, Tulsian A, Joseph V, Gandhi S, Shenoy NS, Shah H. Double intussuscepted patent vitellointestinal duct. J Indian Assoc Pediatr Surg [serial online] 2021 [cited 2023 Mar 26];26:363-4. Available from: https://www.jiaps.com/text.asp?2021/26/5/363/326074




Sir,

This is to review an uncommon and grave presentation of a patent vitellointestinal duct (VID) as double intussusception through the umbilicus. Urgent intervention is warranted to prevent significant bowel loss.

Here, we report a 1-month male baby with patent VID and gangrenous double intussusception through the umbilicus. The patient was a full-term, home-delivered baby boy, feeding well, and passing stools normally after birth. After spontaneous falling off of the umbilical cord on day 6 of life, a protuberant red mass was noticed at the umbilicus with the passage of small amount of fecal matter [Figure 1]a. The parents consulted a local doctor but did not pursue treatment. At 1 month of age, he presented with bilious vomiting, nonpassage of stools for 1 day from the umbilicus or anus, and mild abdominal distension. Two irreducible convoluted loops of edematous bowel protruding from the umbilicus with dark congested mucosal surface were seen with no fecal matter [Figure 1]b. With an extended umbilical incision, a tight constricting ring through which intussusceptions of the proximal and distal loops of the small bowel were emanating was incised. Resection of 40 cm of the devitalized congested bowel and patent VID with primary anastomosis was done [Figure 1]c. Histopathology confirmed gangrenous ileum with a patent VID without any ectopic tissue.
Figure 1: (a) Clinical image of the protuberant fleshy mass at umbilicus from mother's records. (b) Convoluted edematous loops of small bowel protruding out of the umbilicus. (c) Resected specimen showing gangrenous ileum and a short patent vitellointestinal duct

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The embryonic vitellointestinal duct (VID) connects the midgut to the yolk sac and provides nutrition to the growing embryo until the placenta matures. It gradually involutes and separates from the terminal part of ileum during the 5th–9th weeks of gestation.[1],[2] Failure of obliteration leads to various anomalies such as Meckel's diverticulum, umbilical sinus, and patent VID. Patent VID is the complete nonobliteration of the embryonic VID.

VID anomalies occur in approximately 2% of neonates and patent VID in about 6% of these cases. Double intussusception through umbilicus in patent VID is rare with <20 cases in the literature.[3] These intussusceptions are sudden, thrice as more common in males, and present at approximately 1 month of age.[1] Patent VID usually manifests as prolapse of a single loop of small bowel. Rarely, both limbs of the bowel may intussuscept simultaneously through the single umbilical opening which acts as a constricting ring leading to edema, compromised bowel circulation, and gangrene. Predisposing factors for double intussusceptions in a patent VID are a short duct length with a relatively wide umbilical opening. A short length of ileum between the patent VID and ileocecal valve in infants leads to high intraluminal pressure which causes the distal loop to intussuscept in a retrograde fashion.[1] Other complications of patent VID include bleeding, intestinal obstruction, volvulus, internal herniation, and rupture of the patent VID or the protruding bowel due to a sudden increase in the intra-abdominal pressure like crying or severe cough.[4]

Double intussusceptions of a patent VID are a rare and delayed event in neonates who have not had access to treatment or have not sought treatment at presentation. All patent VIDs should be operated at presentation so as to avoid a more catastrophic presentation with bowel gangrene.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
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.  Back to cited text no. 1
    
2.
Kong CK, Zi Xean K, Li FX, Chandran S. Umbilical cord anomalies: Antenatal ultrasound findings and postnatal correlation. BMJ Case Rep 2018;2018:1. doi: 10.1136/bcr-2018-22651.  Back to cited text no. 2
    
3.
Fazal FA, Ndungu JM, Said H, Njiru J, Kambuni F. New-born born with patent VID with prolapsed (intussusceptions) of proximal and distal ileal loop: A case presentation. J Pediatr Surg Case Rep 2017;20:14-6.  Back to cited text no. 3
    
4.
Seid NA, Seman EA. Double intussusception of ileum through patent VID: Case report. Ethiop J Surg 2016;4:24.  Back to cited text no. 4
    


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