Symptomatic vitelline duct anomalies in children
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Published on: August 23, 2022
Emmauel A Ameh1, Philip M Mshelbwala, Mohammed M Dauda
1Division of Paediatric Surgery, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Insights
Patent vitelline ducts (PVDs) are the most common symptomatic anomaly in our environment, despite Meckel's diverticulum (MD) being more frequently reported. This study highlights PVDs in children, emphasizing their clinical presentation and outcomes.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Anomalies
- Congenital Abnormalities
Background:
- Vitelline duct (VD) anomalies result from incomplete obliteration.
- Symptomatic VD anomalies are often attributed to Meckel's diverticulum (MD), overshadowing other presentations.
- A comprehensive review of rare VD anomalies is needed.
Purpose of the Study:
- To review the clinical presentation, diagnosis, and outcomes of symptomatic pediatric vitelline duct anomalies.
- To compare the incidence of patent vitelline ducts (PVDs) versus Meckel's diverticulum (MD) in a pediatric population.
- To highlight the significance of PVDs as a common symptomatic VD anomaly.
Main Methods:
- Retrospective review of 18 pediatric patients with symptomatic VD anomalies over 22 years.
- Analysis of patient demographics, clinical presentation, diagnostic methods, treatment, and outcomes.
- Categorization of anomalies including patent vitelline ducts (PVDs), Meckel's diverticulum (MD), umbilical sinus, and vitelline cysts.
Main Results:
- Patent vitelline ducts (PVDs) were the most common symptomatic presentation (12/18 patients), predominantly in younger children (median 28 days).
- Meckel's diverticulum (MD) occurred in 3 patients, presenting with inflammation, tapeworm incarceration, and volvulus.
- Umbilical sinus (2 patients) and vitelline cyst (1 patient) were also observed. Only one PVD case had associated intestinal malrotation.
- Diagnosis varied from clinical for PVDs to intraoperative for MDs. Treatment involved resection or excision. Complications included adhesions, sepsis, and anesthetic-related deaths.
Conclusions:
- Patent vitelline ducts (PVDs) represent the most frequent symptomatic vitelline duct anomaly in this pediatric cohort, contrary to common reporting focused on Meckel's diverticulum (MD).
- Prompt diagnosis and appropriate surgical management are crucial for PVDs and other rare VD anomalies to prevent complications.
- This study underscores the importance of considering PVDs in the differential diagnosis of symptomatic abdominal conditions in children.
Abstract:
A wide variety of anomalies may occur as a result of the vitelline duct (VD) failing to obliterate completely. Most reports on symptomatic VD focus on Meckel's diverticulum, while other anomalies are given little attention. A retrospective review was conducted at our institution. According to the records 18 symptomatic children with VD anomalies were seen over 22 years, including 10 boys and 8 girls aged 11 days -14 years (median 7.5 months). Twelve patients aged below 10 years (median 28 days) had patent vitelline ducts (PVDs), 3 children aged 13 months, 13 years and 14 years respectively had Meckel's diverticulum (MD), presenting as inflammation, tapeworm incarceration and volvulus respectively. Two patients, both 8 years old, had umbilical sinus, and a 3-year-old had a vitelline cyst. Only 1 patient with PVD had an associated anomaly (intestinal malrotation). The diagnosis of PVD was obvious clinically, but in 1 patient the fistula was demonstrated by fistulogram. The diagnosis of MD was intraoperative in all 3 patients. Treatment was by various types of resection for PVD and MD and excision for umbilical sinuses and cysts. One patient with PVD developed postoperative intestinal obstruction from adhesions, requiring re-laparotomy and adhesiolysis. Two patients with PVD died from sepsis and anaesthetic-related complications, respectively. Although MD is the most commonly VD anomaly, PVD is the most common symptomatic presentation in our environment.
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