Persistence of the omphalomesenteric duct in a newborn

A 21-day-old newborn with undetached umbilical cord was brought to the emergency department. His umbilical cord was thick and moist, with hyperemic and oedematous skin surrounding its base, and granulomatous tissue in the distal segment, without discharge of meconium or urine (Fig. 1). Prior, he had treatment with local cures in ambulatory care.

Initially, the newborn was examined by a paediatric surgeon and an abdominal ultrasound was performed, showing a defect in the anterior abdominal wall with protrusion through the umbilical orifice of a tubular structure (Fig. 2). It was not possible to visualise the intestinal loop in the orifice of the external umbilical protrusion. No persistence of urachal remnant nor other abdominal pathology was identified. 

The study was completed by performing a fistulogram with contrast material injected through the umbilical orifice. Continuity with the distal ileum was revealed confirming the persistence of the omphalomesenteric duct (Fig. 3). The duct was surgically resected (Fig. 4).

Separation of the umbilical cord usually occurs within the first few days of life and can be delayed up to 2 months. Nowadays, plastic tweezers are used a few centimeters above the skin immediately after birth and different topical antimicrobial substances can be applied. These substances may alter the local coloring and provoke delay of the umbilical cord detachment due to decrease in local leukocytes [1].

The most frequent pathology after detachment of the umbilical cord is by far umbilical granuloma [2]. It usually measures less than 1 cm, is red, pediculated and formed by granular tissue with fibroblasts and abundant capillaries. It is easily treated with salt until epithelialisation is achieved. Distinguishing this pathology from others is very important, since an incorrect treatment may have serious consequences. If the treatment fails, we must think of persistent omphalomesenteric duct [2].

The omphalomesenteric (or vitelline) duct is an embryonic structure which connects the yolk sac to the midgut and failure of its resorption results in various anomalies including persistent omphalomesenteric duct, Meckel's diverticulum, fibrous band and umbilical polyp [2]. These anomalies can be seen in up to 2% of the population. The most frequent is Meckel’s diverticulum, while persistent omphalomesenteric duct is infrequent [2].

Persistent omphalomesenteric duct results in a fistulous communication between the distal ileum and the umbilicus [3]. This communication permits an intermittent discharge of enteric contents from the umbilicus which is usually noticed in the first few days of life. It is a very rare abnormality and may be associated with an umbilical polyp.

Ultrasound imaging can be used to identify their relationship and their continuity with the umbilicus and has avoided unnecessary surgical exploration [3].  Also, if the clinical presentation is suspicious, performing an umbilical fistulogram can confirm the diagnosis.

Persistent omphalomesenteric duct should be treated early with laparotomy and excision of the duct to avoid intussusception or volvulus [3].  

Written informed patient consent for publication has been obtained.