© 2020, Farhadi et al
Received Day: 08 Month: 10 Year: 2020
Accepted Day: 30 Month: 10 Year: 2020
J Neonatal Surg. 2020; 9: 31.
DOI: 10.47338/jns.v9.657
Intestinal prolapse through the patent vitellointestinal duct in a preterm newborn
Roya Farhadi Associate Professor of Neonatology, Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Iran.
Seyed Abdollah Mousavi Professor of Pediatric Surgery, Department of Surgery, Mazandaran University of Medical Sciences, Sari, Iran.
[corresp] Roya Farhadi, Associate Professor of Neonatology, Mazandaran University of Medical Sciences, Sari, Iran. E-mail: dr.royafarhadi@gmail.com

Case Presentation

A preterm male neonate was born to a 32-year-old mother at a primary care center by cesarean section (done in view of fetal distress) at 33 weeks of gestation. The amniotic fluid was meconium stained. Antenatal scans were reported normal. Mother had hypothyroidism and was being treated with (100 μg/day) levothyroxine. Birth weight was 2250 grams and Apgar scores were 8-10 at 1 and 5 minutes after birth, respectively. Abdominal examination revealed a red fleshy round shape mass (2×2.5 cm) protruding from the umbilicus along the umbilical cord. The size of the umbilical ring was 1.5 cm in diameter. The mass had no coverage and resembled the intestine with normal colored mucosa (Fig. 1). The anal opening was normally positioned; however, the baby had not passed any meconium and there were no features of intestinal obstruction. A heart murmur was heard on cardiac auscultation. The rest of the systemic examinations were normal. One hour after birth, a dark-greenish discharge was observed through the end of the protruding mass. Intravenous fluids and empirical antibiotics were started. A gradual prolapse of mucosa through the umbilical mass was noted. Ultrasound examination of the abdomen was normal. Echocardiography showed mild left ventricular hypertrophy and tricuspid regurgitation. Pediatric surgery consultation was done, and the newborn was prepared for emergency surgical repair to prevent ischemia and necrosis of the prolapsed intestinal loop. The patient was operated via a circum-umbilical approach 6 hours after birth.

Surgical examination under anesthesia revealed mucosal prolapse of distal ileum through a 3-cm patent vitellointestinal duct (VID). The intestine was healthy with intact vascularity. The patent VID was resected, and bowel anastomosis was done, followed by umbilicoplasty (Fig. 2). There was no urachal anomaly. Feeding was started with expressed breast milk on postoperative day 2 and gradually increased. The baby was on full breastfeeding at day 9 and was discharged home. The baby is doing fine on follow-up (2 months).

Discussion

The persistent omphalomesenteric (vitelline) duct also called vitellointestinal duct (VID) occurs in approximately 2% of the newborns and in 6% the duct remains patent.[1], [2] Patent VID may present itself with intermittent or continuous umbilical discharge.[3], [4] Intestinal prolapse through the patent VID is rare anomaly but is considered as a surgical emergency. Although there is equal frequency between the sexes, symptomatic form is more common in males.[5], [6], [7]

The clinical presentation is variable with very few reported cases of this entity presented at birth and most of the clinical presentations were beyond the first day of life or after neonatal period.[1], [7], [8] It may later present with sudden evisceration of intestine (prolapse) from umbilicus while the baby is crying and if the condition not managed promptly by surgical intervention, may lead to intestinal obstruction, strangulation and gangrene of the prolapsed intestine.[3], [5]

To the best of our knowledge, there are only a few case reports of prolapsing PVID in preterm newborns presenting at birth.[7], [9] The outcome is highly dependent on the time of presentation, early diagnosis, complications (strangulation), and associated anomalies.[7] We believe that PVID need prompt diagnosis and repair as soon as possible to avoid risk of bowel prolapse, ischemia, gangrene, or obstruction.


Figures

Figure 1  

Prolapse of intestine from the umbilicus.



Figure 2  

Mucosal prolapse of distal ileum (B) through the patent vitellointestinal duct (C). A: Proximal intestine, B: Distal intestine, C: Patent vitelline duct, D: Congested cord and its vessels.



Notes

n1Conflicts of interest. The authors declare that they have no conflict of interest

n2Source of Support: Nil

n3Author contributions: Author(s) declared to fulfill authorship criteria as devised by ICMJE and approved the final version. Authorship declaration form, submitted by the author(s), is available with the editorial office.

n4Consent to Publication: Author(s) declared taking informed written consent for the publication of clinical photographs/material (if any used), from the legal guardian of the patient with an understanding that every effort will be made to conceal the identity of the patient, however it cannot be guaranteed..

Acknowledgments

None


References
1. Diouf CH, Ndoye NA, Faye AL, Ndour O, Ngom G. Intestinal prolapse through omphalomesenteric fistula, a rare cause of neonatal occlusion: A case report. J Ped Surg Case Rep. 2016; 10:1-2.
2. 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.
3. Mohite PN, Bhatnagar AM, Hathila VP, Mistry JH. Patent vitellointestinal duct with prolapse of inverted loop of small intestine: a case report. J Med Case Rep. 2007; 1:49.
4. Mundada DD, Kapandis SP. Patent vitellointestinal duct with prolapsed (intussusceptions) of proximal and distal ileal loop: A case report. J Ped Surg Case Rep. 2015; 3:72-4.
5. Sandhu, A. Intestinal prolapse through patent omphalomesenteric duct in a neonate. Indian J Surg. 2020. Available from: https://doi.org/10.1007/s12262-020-02486-3.
6. Pathak A, Agarwal N, Singh P, Dhaneria M. Prolapse of inverted ileal loops through a patent vitellointestinal duct. BMJ Case Rep. 2015; 2015:bcr2015211563.
7. Raheja K, Aggarwal R, Prakash A, Kumar R, Sharma H, Gupta P. Patent vitellointestinal duct with inverted ileal loop prolapse with strangulation at birth in preterm (34 Weeks): A rare presentation. J Surg. 2017; 13:99-100.
8. Roy D, Patra R, Saxena S. Patent vitellointestinal duct with ileal prolapse in a newborn. J Indian Assoc Pediatr Surg. 2015; 20:98.
9. Tadesse A, Kidane P. Patent vitelline duct with gangrenous small bowel prolapse: case report and review of the literature. Ethiop Med J. 2014; 52:207-10.