LETTERS TO THE EDITOR
|Year : 2021 | Volume
| Issue : 5 | Page : 363-364
Double intussuscepted patent vitellointestinal duct
Syamantak Basu, Apoorva Makan, Akriti Tulsian, Vini Joseph, Suraj Gandhi, Neha Sisodiya Shenoy, Hemanshi Shah
Department of Paediatric Surgery, Topiwala National Medical College and B.Y.L Nair Ch. Hospital, Mumbai, Maharashtra, India
|Date of Submission||31-Mar-2021|
|Date of Decision||21-Apr-2021|
|Date of Acceptance||15-Jun-2021|
|Date of Web Publication||16-Sep-2021|
Dr. Neha Sisodiya Shenoy
Department of Paediatric Surgery, Topiwala National Medical College and B.Y.L Nair Ch. Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|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
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., 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. These intussusceptions are sudden, thrice as more common in males, and present at approximately 1 month of age. 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. 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.
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
Conflicts of interest
There are no conflicts of interest.
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