The omphalomesenteric duct (OMD), also known as the vitelline duct, is a tubular structure that connects the yolk sac to the midgut during early embryonic development. It serves as a conduit for the transport of nutrients from the yolk sac to the developing fetus. Normally, the OMD obliterates during fetal development, and any remnants that persist are referred to as omphalomesenteric duct remnants (OMDR).
Types
OMDRs are classified into three main types based on their location:
Meckel’s diverticulum, umbilical sinus, and fibrous cord.
- Meckel’s diverticulum is the most common type of OMDR, accounting for approximately 98% of cases. It is a blind pouch that protrudes from the ileum, typically located within two feet of the ileocecal valve. The diverticulum may be long and narrow, or short and wide, and can vary in size from a few millimeters to several centimeters. It may contain heterotopic tissue, such as gastric or pancreatic tissue, which can lead to complications if it becomes inflamed or obstructed. Meckel’s diverticulum is often asymptomatic but may cause abdominal pain, gastrointestinal bleeding, or intussusception (the telescoping of one segment of the bowel into another). It is usually diagnosed through imaging studies such as ultrasound, CT, or MRI.
- Umbilical sinus OMDRs are rare and typically present as a fistula or sinus tract that opens onto the skin at the umbilicus. They may be associated with other anomalies such as imperforate anus, rectovaginal fistula, or genitourinary abnormalities. Umbilical sinus OMDRs are usually diagnosed clinically, but imaging studies may be helpful in determining the extent of the tract or identifying associated anomalies.
- Fibrous cord OMDRs are the least common type and are characterized by a fibrous band that extends from the ileum to the umbilicus. They are usually asymptomatic and may be discovered incidentally during surgery or imaging studies. Fibrous cord OMDRs do not typically require treatment unless they are causing symptoms such as bowel obstruction or intussusception.
- OMDRs may also be classified based on their histology. Ectopic tissue, such as gastric or pancreatic tissue, may be present within Meckel’s diverticulum and is referred to as a heterotopic OMDR. Heterotopic OMDRs can lead to complications such as peptic ulceration, bleeding, or obstruction. Epithelial OMDRs are lined by columnar or cuboidal epithelium and are typically asymptomatic. They may be associated with other anomalies such as duplications or cysts. Fibrous OMDRs are composed of fibrous tissue and are typically asymptomatic unless they are causing an obstruction.
There are several different types of OMD remnants, each with its own unique characteristics and clinical implications. These include:
- Meckel’s diverticulum: This is the most common type of OMD remnant, occurring in approximately 2% of the population. Meckel’s diverticulum is a pouch that protrudes from the wall of the small intestine, usually located near the ileocecal valve. It is lined with gastric or intestinal mucosa and can contain ectopic tissue such as pancreatic or gastric tissue. Meckel’s diverticulum can become inflamed or even perforate, leading to abdominal pain, diarrhea, and other gastrointestinal symptoms.
- Fibrous bands: Fibrous bands are a type of OMD remnant that occurs when a segment of the OMD fails to completely disappear, leaving behind a fibrous band that connects the small intestine to the umbilicus. This can cause bowel obstruction, which can lead to symptoms such as abdominal pain, vomiting, and constipation.
- Umbilical sinus: An umbilical sinus is a type of OMD remnant that occurs when the OMD fails to completely close off, leaving a communication between the umbilicus and the bowel. This can lead to the development of a draining fistula, which can become infected and cause inflammation and pain.
- Umbilical cyst: An umbilical cyst is another type of OMD remnant that occurs when the OMD fails to close completely, leaving a cystic structure at the umbilicus. Umbilical cysts are usually asymptomatic but can become infected and cause pain or discharge.
- Patent vitellointestinal duct: This is a rare type of OMD remnant that occurs when the entire duct fails to disappear, leaving a communication between the yolk sac and the bowel. This can lead to the development of an umbilical fistula or sinus, as well as other complications such as malrotation of the bowel.
Causes
Causes of omphalomesenteric duct remnant and their associated details.
- Meckel’s diverticulum: Meckel’s diverticulum is the most common congenital anomaly resulting from an omphalomesenteric duct remnant. It is a true diverticulum that arises from the distal ileum and is present in about 2% of the population. Meckel’s diverticulum may remain asymptomatic, or it may present with abdominal pain, gastrointestinal bleeding, or intestinal obstruction.
- Umbilical sinus: Umbilical sinus is a rare condition that occurs when the omphalomesenteric duct fails to close properly, leading to a persistent opening in the umbilicus. Umbilical sinus may be associated with urinary tract abnormalities and recurrent infections.
- Patent vitellointestinal duct: The patent vitellointestinal duct is a rare condition that occurs when the omphalomesenteric duct fails to close completely, leading to persistent communication between the intestine and the umbilicus. This condition may present with fecal discharge from the umbilicus.
- Vitelline cyst: Vitelline cyst is a rare condition that occurs when the omphalomesenteric duct fails to close completely, leading to the formation of a cyst in the umbilical region. Vitelline cysts are usually asymptomatic but may become infected or inflamed.
- Vitelline fistula: Vitelline fistula is a rare condition that occurs when the omphalomesenteric duct fails to close completely, leading to the formation of a fistula between the intestine and the umbilicus. This condition may present with fecal discharge from the umbilicus.
- Omphalocele: Omphalocele is a congenital malformation that occurs when the abdominal contents herniate through a defect in the abdominal wall into the base of the umbilical cord. Omphalocele is often associated with other congenital anomalies and requires surgical intervention.
- Gastroschisis: Gastroschisis is a congenital malformation that occurs when the abdominal contents herniate through a defect in the abdominal wall lateral to the umbilicus. Gastroschisis is often associated with intestinal atresia and requires surgical intervention.
- Enterocystoma: Enterocystoma is a rare condition that occurs when the omphalomesenteric duct fails to close completely, leading to the formation of a cystic mass containing intestinal tissue in the umbilical region. Enterocystomas are usually asymptomatic but may become infected or inflamed.
- Meckel’s diverticulitis: Meckel’s diverticulitis is a complication of Meckel’s diverticulum that occurs when the diverticulum becomes inflamed or infected. Meckel’s diverticulitis may present with abdominal pain, nausea, vomiting, and fever.
- Meckel’s diverticular hemorrhage: Meckel’s diverticular hemorrhage is a complication of Meckel’s diverticulum that occurs when the diverticulum becomes ulcerated and bleeds. Meckel’s diverticular hemorrhage may present with painless rectal bleeding.
- Intestinal obstruction: Intestinal obstruction may occur as a result of various omphalomesenteric
Symptoms
These remnants can cause a variety of symptoms, collectively known as omphalomesenteric duct remnant (OMDR) syndrome. Here are 20 symptoms associated with OMDR, along with their details:
- Abdominal pain: OMDR can cause recurrent abdominal pain, which may be episodic or continuous. The pain is usually located in the umbilical region, but it may also radiate to other parts of the abdomen.
- Constipation: OMDR can cause chronic constipation, which may be due to partial obstruction of the intestine. The stool may be hard and difficult to pass.
- Diarrhea: OMDR can also cause diarrhea, which may be due to incomplete digestion of food or increased secretion of fluid into the intestine.
- Intestinal obstruction: OMDR can cause partial or complete obstruction of the intestine, which may be due to a mass or stricture in the intestine. This can cause severe abdominal pain, vomiting, and constipation.
- Umbilical discharge: OMDR can cause discharge from the umbilicus, which may be serous or purulent. The discharge may be associated with pain, redness, and swelling around the umbilicus.
- Umbilical granuloma: OMDR can cause the formation of a granuloma at the site of the umbilicus. This is a small, red, raised bump that may discharge pus or blood.
- Umbilical polyp: OMDR can cause the formation of a polyp at the site of the umbilicus. This is a small, fleshy growth that may bleed or discharge fluid.
- Umbilical sinus: OMDR can cause the formation of a sinus at the site of the umbilicus. This is a small, tunnel-like passage that may discharge pus or fluid.
- Umbilical cyst: OMDR can cause the formation of a cyst at the site of the umbilicus. This is a fluid-filled sac that may be painless or cause discomfort.
- Umbilical hernia: OMDR can cause an umbilical hernia, which is a protrusion of the intestine through the abdominal wall at the site of the umbilicus. This can cause a bulge or lump in the abdomen.
- Meckel diverticulum: OMDR can cause the persistence of a Meckel diverticulum, which is a small pouch in the intestine that is present in some individuals at birth. This can cause abdominal pain, diarrhea, and other gastrointestinal symptoms.
- Intussusception: OMDR can cause intussusception, which is a condition in which one part of the intestine slides into another part of the intestine. This can cause severe abdominal pain, vomiting, and bloody stools.
- Gastrointestinal bleeding: OMDR can cause gastrointestinal bleeding, which may be due to inflammation or ulceration of the intestine. This can cause bloody stools or vomiting of blood.
- Malabsorption: OMDR can cause malabsorption, which is a condition in which the intestine is unable to absorb nutrients from food. This can cause weight loss, fatigue, and other symptoms of malnutrition.
- Failure to thrive: OMDR can cause failure to thrive, which is a condition in which a child does not gain weight or grow normally. This can be due to malnutrition, chronic illness, or other factors
Diagnosis
Diagnosis and tests for OMDR, explaining their details and indications.
- Physical examination: A physical examination can provide some clues regarding the presence of OMDR, such as an umbilical mass, a draining sinus, or tenderness in the abdominal region. However, the physical exam may not always be conclusive, and further tests may be necessary.
- Ultrasound: An abdominal ultrasound can be useful in detecting an OMDR, particularly if it presents as a cyst or a solid mass. Ultrasound can also help assess the size and location of the remnant and its relation to nearby organs.
- CT scan: A CT scan can provide a more detailed evaluation of the OMDR, particularly if it presents as a fistula or a sinus. CT can also help detect any complications, such as perforation or abscess formation.
- MRI: An MRI can be helpful in evaluating the soft tissue structures and assessing the exact location and extent of the OMDR. MRI can also help detect any associated anomalies, such as intestinal malrotation.
- Barium swallow: A barium swallow is a radiological test that involves drinking a contrast agent and then having X-rays taken to evaluate the gastrointestinal tract. This test can be useful in detecting an OMDR if it presents as a diverticulum or a fistula.
- Barium enema: A barium enema is a radiological test that involves the introduction of a contrast agent into the rectum and colon to evaluate the large intestine. This test can be useful in detecting an OMDR if it presents as a fistula or a diverticulum.
- Upper endoscopy: Upper endoscopy involves the insertion of a flexible tube with a camera into the mouth to evaluate the esophagus, stomach, and duodenum. This test can be useful in detecting an OMDR if it presents as a fistula or a sinus involving the upper gastrointestinal tract.
- Colonoscopy: Colonoscopy involves the insertion of a flexible tube with a camera into the rectum to evaluate the large intestine. This test can be useful in detecting an OMDR if it presents as a fistula or a sinus involving the large intestine.
- Meckel’s scan: A Meckel’s scan is a nuclear medicine test that involves the injection of a radioactive tracer to evaluate the presence of Meckel’s diverticulum, which is a common type of OMDR. This test can be useful in detecting the presence of Meckel’s diverticulum and assessing its location and size.
- Technetium-99m pertechnetate scan: A technetium-99m pertechnetate scan is a nuclear medicine test that involves the injection of a radioactive tracer to evaluate the presence of ectopic gastric mucosa, which can occur in association with some OMDRs. This test can be useful in detecting the presence of ectopic gastric mucosa and assessing its location and extent.
- Fistulography: Fistulography is a radiological test that involves injecting a contrast agent into a fistula tract to evaluate its course and extent.
Treatment
Treatments for OMDR.
- Observation and monitoring: In asymptomatic cases, observation and monitoring can be an appropriate management option. The patient may be advised to undergo regular checkups and imaging to monitor the size and growth of the OMDR.
- Antibiotics: Antibiotics may be prescribed in cases of infection or suspected infection.
- Analgesics: Analgesics can be used to relieve pain associated with OMDR.
- Intravenous fluids: Intravenous fluids may be administered in cases of dehydration or electrolyte imbalance.
- Bowel rest: In cases of intestinal obstruction or inflammation, bowel rest may be necessary. This involves avoiding oral intake and providing nutrition through parenteral routes.
- Nasogastric tube placement: In cases of intestinal obstruction or distension, a nasogastric tube may be placed to decompress the bowel and relieve symptoms.
- Surgical excision: Surgical excision of the OMDR may be necessary in cases of complications such as bleeding, perforation, or obstruction. The surgical approach may vary depending on the type and location of the OMDR.
- Laparoscopic surgery: Laparoscopic surgery is a minimally invasive approach that involves making small incisions and using a laparoscope to visualize and remove the OMDR.
- Open surgery: Open surgery involves making a large incision to access and remove the OMDR. This approach may be necessary in cases of complex or large OMDR.
- Meckel diverticulum resection: Meckel diverticulum is the most common type of OMDR and may require surgical resection. This involves removing the diverticulum along with any associated complications such as inflammation or bleeding.
- Umbilical cyst excision: In cases of umbilical cyst, surgical excision may be necessary to prevent complications such as infection or rupture.
- Umbilical sinus excision: In cases of umbilical sinus, surgical excision may be necessary to prevent complications such as infection or abscess formation.
- Fibrous cord division: Fibrous cord is a type of OMDR that may cause intestinal obstruction. In such cases, surgical division of the cord may be necessary to relieve the obstruction.
- Endoscopic removal: Endoscopic removal may be an option for certain types of OMDR such as polyps or small diverticula.
- Sclerotherapy: Sclerotherapy involves injecting a sclerosing agent into the OMDR to induce fibrosis and shrinkage. This approach may be useful in cases of bleeding or infection.
- Radiofrequency ablation: Radiofrequency ablation involves using a high-frequency electrical current to destroy tissue. This approach may be useful in cases of small OMDR.
- Laser ablation: Laser ablation involves using a laser to destroy tissue. This approach may be useful in cases of small OMDR.
- Cryotherapy: Cryotherapy involves using extreme cold to destroy tissue. This approach may be useful in cases of small OMDR.
References
Previous
Omphalomesenteric Duct Cyst
Next
