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CASE REPORT
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Inverted ileal loop prolapse through patent vitellointestinal duct


 Department of Surgery, Alam Hospital and Research Centre, Ranchi, Jharkhand, India

Date of Submission16-May-2020
Date of Decision22-Jul-2020
Date of Acceptance23-Jul-2020

Correspondence Address:
Prashant Kumar,
Flat-204, Puspanjali Complex, Mandir Marg, Jaiprakash Nagar, Bariatu, Ranchi - 834 009, Jharkhand
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_260_20

  Abstract 


Patient vitellointestinal duct (VID) is not very common because of its varied presentation and complication, and the prolapse of an inverted ileal loop through patent VID is an extremely rare presentation. Here, we report a case of a 4-month-old boy of patent VID through which distal half of the inverted ileal loop got prolapsed, appearing as Y loop. Emergency laparotomy was done. The ileal loop was reduced and resection anastomosis of the involved ileal segment was performed.

Keywords: Emergency laparotomy, patent vitellointestinal duct, Y-shaped loop



How to cite this URL:
Kumar P, Alam M. Inverted ileal loop prolapse through patent vitellointestinal duct. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Nov 30]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=319171




  Introduction Top


A completely patient vitellointestinal duct (VID) with inverted loop of ileum is very rare anomaly. Less than 10 cases have only been reported in literature and out of which only 3 cases are with this similar presentation till now.[1],[2],[3],[4] It is more common in a male child. The midgut enlarges rapidly during the first 5 weeks of gestation and becomes too large for the abdominal cavity; subsequently, it is herniated into the umbilical cord. The apex of the herniated midgut is continuous with the VID and the yolk sac. The axis of the herniated midgut is formed by the superior mesenteric artery.[1] Once 10th week of gestation is reached, it follows return of midgut into abdominal cavity via various complex developmental processes. If omphalomesenteric duct remains patent, lot of bowel anomalies might result in from bowel pathology to VID anomaly.


  Case Report Top


The patient is a 4-month-old boy who was brought to the casualty with red-colored Y-shaped loop on the anterior abdominal wall from the umbilical area. History revealed that he was full-term normal delivery, weight around 2.5 kg, and cried immediately after birth. His mother said that the baby had cough and fever on and off for the last 5 days. His parents noticed watery discharge from the umbilicus for the last 2 days and noticed a red-colored mass of around 1 cm × 1 cm from the umbilicus, which became like this within 5 h.

General physical examination revealed tachycardia with no fever during presentation. Per abdomen examination had finding of two loops of intestine prolapsing from the umbilicus, forming a Y shape. The loop was irreducible with appearance suggestive of mucosal surface [Figure 1].
Figure 1: Picture at presentation

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Laboratory investigation including full hemogram, biochemistry, and coagulation profile was normal. After adequate preparation, the child was taken up for emergency laparotomy. Transverse 5-cm subumbilical incision under general anesthesia was made. Stem of Y was firmly adherent with anterior abdominal wall released with sharp dissection. On exploration, two different loops of the inverted ileum were entering that Y fork. Reduction of the distal and proximal loop was performed and Y fork disappeared [Video will be available on website]. There was a defect of 1 cm × 1 cm in the ileum, adherent to the umbilicus and was patent. Hence, it was diagnosed as patent VID with inverted loop of the ileum. Bowel vascularity was not compromised due to early presentation, so resection anastomosis of the ileal segment with defect was done. Postoperative period was uneventful and the patient was discharged on the 10th day.


  Discussion Top


Vitellointestinal duct which connects the primitive gut to the yolk sac generally gets obliterated by the 8th week; if it fails, it will result in various congenital anomalies such as Meckel's diverticulum, enteric cyst, umbilical sinus, fistula, umbilical.[5] A completely patent VID is very rare anomaly, which was first reported in 1985 by Gvalani et al.[2]

Sudden increase in intra-abdominal pressure (e.g., cough) can lead to prolapse of intestine partially or completely through the patent VID. Although it is rare, this anomaly can easily be diagnosed by its typical presentation. Mohite PN has presented it very nicely in his report.[1]

Emergency laparotomy is the treatment of choice in view of threatened complication of intestinal obstruction, strangulation, intussusception, and possibility of prolapsed loop gangrene.[6],[7] Outcome depends on time of presentation, associated anomaly, and early diagnosis.

Based on timing of presentation (whether early or late),viability,edema of bowel loop and size of defect,treatment can be decided.

  1. In early presentation, with viable loop, minimal bowel edema, and small defect, primary closure of VID can be done
  2. In early presentation, with viable loop, minimal edema, and large defect, resection anastomosis of that segment can be done
  3. In late presentation, doubtful loop viability better is to exteriorize that segment or loop ileostomy followed by closure after 6 weeks is acceptable.


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the parents have given their consent for images and other clinical information to be reported in the journal. The parents understand that the patient's name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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.  Back to cited text no. 1
    
2.
Gvalani AK, Acharya GV, Rao RV, Dawookkar VV. Ileal prolapse through a patent vitello intestinal. Indian Pract 1985;38:629-32.  Back to cited text no. 2
    
3.
Zea MI, Chana RS, Anees A, Khan S. Inverted ileal prolapse through patent vitello intestinal duct: A case report. Internet J Paediatr Neonatol 2009;10:2.  Back to cited text no. 3
    
4.
Benson JM, Sparnon AL. Double intussusception of ileum through a patent vitello-intestinal duct: Report of a case and literature review. Aust N Z J Surg 1992;62:411-3.  Back to cited text no. 4
    
5.
Chiang LS. Vitelline duct remnant appearing as a hemorrhagic umbilical mass. JAMA 1982;247:2812-3.  Back to cited text no. 5
    
6.
Ladd WF, Gross RE. Abdominal Surgery of Infancy and Childhood. Philadelphia: W B Saunders and Co; 1941. p. 72.  Back to cited text no. 6
    
7.
Lister J, Irving I. 'Neonatal Surgery' Umbilical Anomalies. 3rd ed., Ch. 27. London, Butterworth & Co; 1990. p. 397.  Back to cited text no. 7
    


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