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Published on: August 23, 2022
Symptomatic omphalomesenteric duct anomalies in children
G Gerçel1,2, A I Anadolulu3,4
1Department of Paediatric Surgery, Şanlıurfa Training and Research Hospital, Turkey.
Insights
Symptomatic omphalomesenteric duct (OMD) anomalies in children often present with gastrointestinal obstruction. Surgical intervention is the definitive treatment, though complex resections may be necessary due to complications and ectopic tissue presence.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Developmental Biology
Background:
- Omphalomesenteric duct (OMD) anomalies are congenital conditions arising from the incomplete obliteration of the omphalomesenteric duct.
- These anomalies can lead to various gastrointestinal and umbilical presentations in children.
- Understanding their characteristics is crucial for timely diagnosis and management.
Purpose of the Study:
- To describe the clinical experience with symptomatic OMD anomalies in pediatric patients.
- To evaluate patient demographics, presenting symptoms, surgical treatments, and outcomes.
- To identify challenges associated with managing these anomalies.
Main Methods:
- Retrospective analysis of pediatric patients operated for symptomatic OMD anomalies.
- Data collection from October 2018 to November 2022 at Şanlıurfa Training and Research Hospital.
- Review of patient records, surgical findings, and histopathological reports.
Main Results:
- 35 patients (82.8% male) with a median age of 31.7 weeks presented with gastrointestinal tract obstruction (48.6%), acute abdomen (31.4%), umbilical abnormalities (11.4%), or rectal bleeding (8.6%).
- Umbilical anomalies were exclusively observed in newborns.
- Surgical findings included Meckel's diverticulitis (40%), intussusception (25.7%), and Meckel's band obstruction (22.9%). Ectopic gastric and/or pancreatic tissue was found in approximately 37% of resected specimens.
- Postoperative complications were minimal (5.7%), with all patients surviving.
Conclusions:
- Gastrointestinal obstruction is the predominant symptom of symptomatic OMD anomalies in children.
- Surgical management is definitive, with wedge resection and simple diverticulectomy being options, but more extensive resections are sometimes required.
- The presence of ectopic tissue and potential for severe complications highlight the complexities in managing OMD anomalies.
Background:
We aimed to present our experience with children with symptomatic omphalomesenteric duct (OMD) anomalies and evaluate the patients' characteristics, treatment, and outcomes.
Methods:
Records of children who were operated for symptomatic OMD anomalies in Şanlıurfa Training and Research Hospital between October 2018 and November 2022 were retrospectively analysed.
Results:
There were 35 patients with a median age of 31.7 (1 day-17 years) weeks, 29 (82.8%) males and six (17.2%) females. The presenting signs were gastrointestinal tract (GIT) obstruction in 17 (48.6%) patients, acute abdomen in 11 (31.4%), umbilical abnormalities in four (11.4%) and rectal bleeding in three (8.6%). All patients presenting with umbilical abnormalities were newborn. These were OMD fistula to skin (n = 1), OMD fistula to umbilical cord hernia sac (n = 1), OMD cyst in umbilical cord hernia (n = 1) and OMD band adherence to umbilical cord hernia sac (n = 1). Meckel's scan was positive in all three patients with rectal bleeding. Surgical findings in patients other than umbilical abnormalities were diverticulitis (with/without perforation) (n = 14), intussusception due to diverticulum (n = 9) and Meckel's band obstruction (n = 8). At surgery, an ileal resection was performed in 19 cases, wedge resection in 10 cases, resection with stapler in five cases and ileocolonic resection in one patient. On histopathological examination, ectopic gastric mucosa was detected in 11 specimens and both gastric and pancreatic tissue in two. There were only two cases of postoperative complications (incisional hernia, n = 1, postoperative colon perforation due to forced manual reduction of intussusception, n = 1) and all patients survived in good condition.
Conclusion:
In the present study, GIT obstruction is the primary symptom in patients with symptomatic OMD anomalies, with umbilical anomalies exclusively found in newborns. Surgery is confirmed as the definitive treatment, with wedge resection and simple diverticulectomy being safe but sometimes insufficient. A significant portion of patients might need more complex segmental bowel resections due to severe complications. With ectopic tissue found in about one-third of cases, managing OMD anomalies presents distinct challenges.
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