Soumyodhriti Ghosh, Abhijit Kundu, Sunaram Majhi, Hari Ignatius Pandey, Abhishek Kumar.
Pediatric Surgery unit, Abhishek Child care Hospital, Jamshedpur, India.
ADDRESS FOR CORRESPONDENCE
Soumyodhriti Ghosh, Pediatric Surgery unit, Abhishek Child Care hospital, Sakchi, Jamshedpur 831001.
Email: drsghosh.surg85@gmail.com. | | Keywords | | bowel prolapse, umbilicus, newborn, vitellointestinal duct. | | | The vitello intestinal duct commonly regresses at birth. Embryologically if the duct continues to persist beyond eighth week of gestation, it leads to various manifestations after birth. Patent VID may be symptomless in a child or may have varied manifestations, some of which may be life threatening. The serious symptoms may be volvulus, intussusception and other causes of intestinal obstruction.1,2 Intussusception is rare and in this condition, the patient may have a bowel loop prolapse from the umbilical opening.1,2,3 This is a rare condition leading to parental anxieties and merits mention due to its uniqueness in presentation and management.
A twenty-eight days old newborn with no significant antenatal or immediate postnatal history was brought by anxious parents to the emergency with something protruding the umbilicus. A bowel loop was noted coming out of the umbilical opening, dusky in colour. The patient was prepared for emergency surgery. On exploration, findings noted of a loop of ileum that was protruding through the opening in the umbilicus. A perforation was noted in the patent vitello intestinal duct from which the ileal loop was intussuscepting through. The intussusception was carefully reduced back and the perforation was closed. The patient recovered uneventful and went home.
Vitello intestinal duct or omphalo mesenteric duct is an embryological remnant that connects the primitive yolk sac to the midgut. It is generally persistent up to the eighth week after which obliteration is noted.1 The small bowel intussuscepting through the patent duct is very rare and close to fifteen cases have been reported as mentioned in the references .1,2 Wide umbilical defects with symptoms of faecal contamination coming are more likely to have bowel prolapse. The herniation is commonly noted with increased abdominal pressure like prolonged crying or constipation. As the patent duct lies close to the ileocaecal valve, the ileum appears to be the commonest bowel to prolapse through the umbilicus with prolonged rise in abdominal pressure.2,3,4
Considering the probabilities of complications, a newborn presenting with stool coming from the umbilicus should be urgently operated upon. These patients can present with a plethora of life threatening complications, of which prolapse of the ileum is the rarest. Resection of the vitello intestinal duct with ileo ileal anastomosis is the standard treatment.1,2,5
| | | | Compliance with Ethical Standards | | Funding None | | | | Conflict of Interest None | | |
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- Lone YA, Bawa M, Sundaram J, Rao KL. Omphalocele with double prolapse of ileum through patent vitellointestinal duct: a rare presentation. Journal of the Korean Association of Pediatric Surgeons. 2015 Jun 1;21(1):14-6. [CrossRef]
- Mohite PN, Bhatnagar AM, Hathila VP, Mistry JH. Patent vitellointestinal duct with prolapse of inverted loop of small intestine: a case report. Journal of Medical Case Reports. 2007 Dec;1(1):1-4. [CrossRef] [PubMed] [PMC free article]
DOI: https://doi.org/10.7199/ped.oncall.2023.49
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| Cite this article as: | | Ghosh S, Kundu A, Majhi S, Pandey H I, Kumar A. Bowel prolapse through umbilicus in newborn - an unforeseen emergency. Pediatr Oncall J. 2023;20: 59. doi: 10.7199/ped.oncall.2023.49 |
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