Herniation of a Meckel’s diverticulum in the Umbilical Cord

Ben Gys*, 1; Daphnée Demaeght2; Guy Hubens3; Martin Ruppert3; Wouter Vaneerdeweg 3

1. Department of Surgery, AZ St Dimpna, Geel, Belgium , 2. Department of Pediatrics, University Hospital Antwerp, Belgium , 3. Department of Abdominal Surgery, University Hospital Antwerp, Belgium

Correspondence: *. Correspondence: Ben Gys, J.B. Stessensstraat 2 - 2440 Geel, Belgium. Email: E-mail: .

Received: 2014 September 23; Accepted: 2014 October 9

J Neonat Surg. 2014 Oct 20; 3(4): 52

Copyright

Copyright: © 2014 JNS


A female neonate born at term with a mass at the umbilicus (Fig. 1). Prenatal ultrasound at 22 weeks gestation had noted polyhydramnios, macrosomia, a single umbilical artery and a small ventricular septum defect. Fluorescence in situ hybridization (FISH) analysis at 27 weeks gestation did not identify any chromosomal abnormalities. At birth, the umbilical ring seemed intact and there was no real abdominal wall defect. Initially, a manual reduction of the hernia was established, yet it reoccurred almost immediately. Surgical exploration revealed a herniated Meckel’s diverticulum in the umbilical cord.

Umbilical cord herniation is a rare (approximately 1-5000 live births) embryopathy, which is sporadically associated with other congenital anomalies [1]. The herniation is caused by the failure of the return of midgut into the celomic cavity at 10-14 weeks amenorrhea [2]. The coverings of the hernia are a thin membrane (Rathke’s membrane – continuous with the parietal peritoneum), Wharton’s jelly and a thin amniotic layer. There is no major abdominal wall defect with normal insertion of the rectus muscles in the xiphoid and the umbilical ring is intact. These are not the case in an omphalocele. As the ring might be too narrow to allow a spontaneous reduction, herniation of intra-abdominal organs could result in ischemia and necrosis. For that reason careful examination is vital. Furthermore, postnatal clamping of a herniated cord could result in an iatrogenic injury. Nowadays the umbilical cord herniation is mostly diagnosed during early prenatal screening [3]. This helps in pre- and postnatal decision making. The major criterion for differentiating a congenital hernia from an omphalocele is the morphology of the umbilical cord insertion i.e. the intactness of the umbilical ring. Herniation of the umbilical cord is sporadically associated with anomalies like an ileal atresia, cloacal anomalies or like in this case a persistent vitello-intestinal duct [4, 5].


[Figure ID: F1] Figure 1: Impression of the umbilical cord herniation.

Footnotes

Source of Support: Nil

Conflict of Interest: Nil


References
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2. Klein MD, Hertzler JH. Congenital defects of the abdominal wall. Surg Gynecol Obstet. 1981; 152: 805-8.
3. Achiron R, Soriano D, Lipitz S, Mashiach S, Goldman B, Seidman DS. Fetal midgut herniation into the umbilical cord: improved definition of ventral abdominal anomaly with the use of transvaginal sonography. Ultrasound Obstet Gynecol. 1995; 6: 256-60.
4. Pal K, Ashri H, Al Wabari A. Congenital hernia of the cord. Indian J Pediatr. 2009; 76: 319-21.
5. Burns C. W, Ogryzlo M. A. Congenital hernia into the umbilical cord; two cases, one associated with persistent cloaca. Can Med Assoc J. 1938; 39: 438-441.

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